Medication	Dosing information	Common adverse effects	Monitoring recommendations	Comments
Antipsychotics, atypical	Varies	Akathisia, dry mouth, extrapyramidal effects, hyperglycemia, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension, sexual dysfunction, somnolence, tardive dyskinesia, weight gain	Lipid profile, fasting, baseline and annually; blood glucose level at baseline and as indicated; waist circumference, body weight, and CBC in patients with prior clinically significant leukopenia; measure at baseline and then as clinically indicated AIMS testing* at least twice per year40	Risperidone (Risperdal) and ziprasidone (Geodon) increase the risk of extrapyramidal effects Aripiprazole (Abilify), ziprasidone, and lurasidone (Latuda) are less associated with metabolic adverse effects but have higher risk of akathisia Caution should be used when decreasing dosages because rebound anxiety and psychosis are possible Increased risk of death in older patients with dementia†
Antipsychotics, typical  Haloperidol	2 to 5 mg intramuscularly for acute episode; may repeat every hour as needed until symptoms are controlled; switch to oral form as soon as feasible Initial dosage is based on patient's age and severity of symptoms; dosage rarely should exceed 100 mg in 24 hours No recommendation for use after acute episode	Anxiety, blood dyscrasia, depression, extrapyramidal effects, headache, hyperprolactinemia, hypotension, insomnia, neuroleptic malignant syndrome, pneumonia, psychosis, QT prolongation, restlessness, sedation, seizures, tardive dyskinesia, weight gain	CBC (in patients with prior clinically significant leukopenia) at baseline and monthly in the first three months of therapy Prolactin level as clinically indicated Monitor for extrapyramidal effects, tardive dyskinesia (AIMS testing* at least twice per year),40 and neuroleptic malignant syndrome	Increased risk of death in older patients with dementia† Torsades de pointes possible, particularly with higher than recommended dosages
Benzodiazepines  Lorazepam (Ativan)	0.5 to 2 mg orally or intramuscularly, up to 4 mg per day Reduce dosage by 50% in patients who are older and debilitated, patients taking valproate (Depacon), and patients with hepatic or renal disease	Agitation, anterograde amnesia, blood dyscrasia, cognitive impairment, depression, extrapyramidal effects, nausea, respiratory hyponatremia, sedation, syndrome of inappropriate antidiuretic hormone	Periodic CBC and liver function testing for patients on long-term therapy	Contraindicated in patients with myasthenia gravis or acute narrow-angle glaucoma Avoid in patients with history of substance use disorder Continuous long-term use not recommended Paradoxical reactions are more likely in children and older persons; risk of seizure after discontinuation is greater in patients with preexisting seizure disorder and in those taking antidepressants
Carbamazepine (Tegretol)	200 to 1,600 mg orally per day Begin with 200 mg twice per day, adjusting every day by 200 mg as tolerated Titrate to serum level of 4 to 12 mcg per mL	Ataxia; fatigue; headache; hyponatremia; leukopenia; nystagmus; rash, including Stevens-Johnson syndrome and toxic epidermal necrolysis†	Serum carbamazepine levels every one to two weeks initially, then every three to six months or before and after dosage changes CBC and liver function testing monthly for the first two months, then every three to 12 months thereafter Screening for HLA-B1502 in patients with Asian ancestry; patients with positive screening results should avoid carbamazepine because of the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis	Slower titration mitigates adverse effects Hyponatremia occurs in up to 40% of patients Carbamazepine may induce its own metabolism; dose increase after initial titration may be required
Valproic acid (Depakote)	Target dosage: 1,000 to 3,000 mg orally per day 15 to 20 mg per kg load in patients with acute mania; may also start with 500 to 750 mg per day in divided doses and adjust every two to three days as tolerated Titrate to serum level of 50 to 125 mcg per mL	Diarrhea, elevated liver transaminase levels, hair loss, hepatic failure,† leukopenia, nausea, pancreatitis,† polycystic ovary syndrome, sedation, thrombocytopenia, tremor, weight gain	Serum valproic acid levels every one to two weeks initially, then every three to six months or before and after dosage changes CBC and liver function testing monthly for the first two months, then every three to 12 months thereafter Can increase ammonia level, so consider testing for patients with mental status change or lethargy	Polycystic ovary syndrome is common in women who start treatment before 20 years of age Adding lamotrigine (Lamictal) to valproic acid increases the risk of serious rash Teratogenic†
Lamotrigine	200 mg orally per day Begin with 25 mg per day and titrate over six weeks; titration and dosage adjustments differ for those taking valproic acid, carbamazepine, phenytoin (Dilantin), phenobarbital, primidone (Mysoline), rifampin, and oral contraceptives	Aseptic meningitis; dizziness; dry mouth; headache; hemophagocytic lymphohistiocytosis; leukopenia; nausea; pancytopenia; rash, including Stevens Johnson syndrome and toxic epidermal necrolysis†; somnolence; thrombocytopenia; tremor	CBC and liver function testing monthly for the first two months, then every three to 12 months thereafter Ask about any new rashes at each visit	Incidence of skin rash is reduced with slow titration and not exceeding recommended dosage; adding lamotrigine to a patient currently taking valproic acid increases the risk of serious rash Incidence of serious rash in adults is 0.08% with monotherapy Adverse reactions mainly occur in the first two to eight weeks of therapy, rarely as late as six months after treatment initiation
Lithium	900 to 1,800 mg orally per day Begin with up to 300 mg twice per day and adjust dosage every two or three days as tolerated; titrate to serum level of 0.6 to 1.5 mEq per L	Cognitive effects, diabetes insipidus, diarrhea, hypothyroidism, nausea, polyuria, sedation, thirst, tremor, weight gain	Serum lithium levels every one to two weeks initially, then every three to six months thereafter or before and five days after dosage changes or with the addition of medications affecting renal function‡ Thyroid function testing§ and renal indices every two or three months in the first six months of therapy, then every six to 12 months thereafter	Toxicity is dose dependent; overdose can be fatal† Incidence of hypothyroidism is higher in women and increases with age High rates of withdrawal compared with valproic acid and lamotrigine in maintenance therapy