Indications: schizophrenia; mania, either alone or with mood stabilisers; depression in bipolar disorder; adjunctive treatment in major depressive disorder.

Cautions: cerebrovascular disease; patients at risk of aspiration pneumonia; treatment of depression in patients under 25 years (increased risk of suicide)

Contra-indications: cerebrovascular disease; patients at risk of aspiration pneumonia; treatment of depression in patients under 25 years (increased risk of suicide)

Hepatic impairment: for immediate-release tablets, initially 25 mg daily, increased daily in steps of 25–50 mg; for modified-release tablets, initially 50 mg daily, increased daily in steps of 50 mg.

Pregnancy: use only if potential benefit outweighs risk

Breast-feeding: manufacturer advises avoid

Side Effects: dyspnea, elevated plasma-triglyceride and - cholesterol concentrations, peripheral oedema, increased appetite, sleep disorders, irritability, dysarthria, asthenia; less commonly rhinitis, restless legs syndrome, hyponatraemia, hypothyroidism; rarely pancreatitis, hepatitis; very rarely inappropriate secretion of antidiuretic hormone, rhabdomyolysis, angioedema, Stevens-Johnson syndrome; also reported suicidal behaviour (particularly on initiation), toxic epidermal necrolysis

Dose: Schizophrenia, ADULT over 18 years, 25 mg twice daily on day 1, 50 mg twice daily on day 2, 100 mg twice daily on day 3, 150 mg twice daily on day 4, then adjusted according to response, usual range 300–450 mg daily in 2 divided doses; max. 750 mg daily; CHILD : Not recomended Treatment of mania in bipolar disorder, ADULT over 18 years, 50 mg twice daily on day 1, 100 mg twice daily on day 2, 150 mg twice daily on day 3, 200 mg twice daily on day 4, then adjusted according to response in steps of up to 200 mg daily to max. 800 mg daily; usual range 400–800 mg daily in 2 divided doses; Treatment of depression in bipolar disorder, ADULT over 18 years, 50 mg once daily (at bedtime) on day 1, 100 mg once daily on day 2, 200 mg once daily on day 3, 300 mg once daily on day 4; adjust according to response, usual dose 300 mg once daily, max. 600 mg daily Prevention of mania and depression in bipolar disorder, ADULT over 18 years, continue at the dose effective for treatment of bipolar disorder and adjust to lowest effective dose; usual range 300–800 mg in 2 divided doses.

Note: The rate of dose titration may need to be slower and the daily dose lower in elderly patients,