Taking medication

Before starting any medication for bipolar disorder

Your doctor should measure your weight and do some blood and urine tests. They may also check your heart using a test called an electrocardiogram (called an 'ECG' for short). If you will be taking an antipsychotic they should also check your pulse and blood pressure.

Side effects

Medication for bipolar disorder often has side effects. Your doctor should discuss these with you. When you are taking medication they should ask you at every appointment whether you're having any side effects. In between appointments, tell your doctor if you are having side effects or other problems with your medication.

Alcohol, smoking and taking other medicines

Your doctor should tell you that drinking alcohol, smoking or taking other drugs while taking medication for bipolar disorder could stop the medication from working properly and make your symptoms worse.

You should not be offered medication called gabapentin or topiramate to treat bipolar disorder.

Antipsychotic medication

While you are taking antipsychotic medication, your doctor should:

  • measure your weight every week for the first 6 weeks

  • check your pulse and blood pressure each time your dose is changed

  • do a blood test to measure your blood sugar and cholesterol levels, and measure your weight again, after 3 months.

You should not be offered more than one antipsychotic at the same time, except for a short period if you are changing from one medication to another.

Lithium

While you are taking lithium, your doctor should:

  • do a blood test every week to check how much lithium is in your blood until you are taking the right dose, and then every 3 months for the first year

  • do a blood test every 6 months after the first year, or every 3 months if you are aged 65 or over, are taking other medication, have poor symptom control, have problems taking lithium or are at risk of other health problems

  • measure your weight, do a urine test and check how well your thyroid is working at least every 6 months.

Taking lithium safely

Your doctor should give you information about how to take lithium safely and tell you to:

  • take lithium regularly and not miss doses

  • call them if you have diarrhoea or vomiting or you become very unwell for any reason

  • make sure you drink enough water, particularly after exercise, in hot weather or during illness

  • talk to them as soon as possible if you become pregnant or are planning a pregnancy

  • not take non‑steroidal anti‑inflammatory drugs (NSAIDs for short), such as ibuprofen and aspirin.

Valproate

Valproate can harm unborn babies. You should not take valproate if there is any possibility that you are or will become pregnant.

While you are taking valproate, your doctor should:

  • measure your weight after 6 months and every year after that

  • do a full blood test and check how well your liver is working every 6 months and every year after that.

Your doctor should explain to you how to recognise signs of liver or blood problems that can be caused by valproate. If you have any of these signs contact your doctor straight away.

Lamotrigine

If you are taking lamotrigine, tell your doctor if you are pregnant or planning a baby.

If your dose of lamotrigine has been increased, tell your doctor straight away if you develop a rash.

Stopping medication

If you decide to stop taking medication, your doctor should discuss with you how to tell if you are becoming unwell again and what to do if that happens. You should stop your medication gradually over at least 4 weeks. Your doctor should check to make sure you are not becoming unwell again while you are stopping medication and for the next 2 years.

Off‑label medicines

In the UK, medicines are licensed to show that they work well enough and are safe enough to be used for specific conditions and groups of people. Some medicines can also be helpful for conditions or people they are not specifically for. This is called 'off‑label' use. Off‑label use might also mean the medicine is taken at a different dose or in a different way to the licence, such as using a cream or taking a tablet.

In this information some medications are recommended for off‑label use. If your doctor offers you one of these they should tell you this and explain what it means for you.

There is more information about licensing medicines on the NHS website.

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