Drug

Geriatric Dosage

Adverse Effects

Comments

Carbamazepine^OL*

200–1000 mg/day (therapeutic level 4–12 μg/mL)

Nausea, fatigue, ataxia, blurred vision, hyponatremia

Poor tolerability in older adults; must monitor CBC, LFTs, electrolytes q 2 weeks for first 2 months, then q 3 months

Lithium^OL*

150–1000 mg/day

(therapeutic level 0.5–0.8 mEq/L)

Nausea, vomiting, tremor, confusion, leukocytosis

Poor tolerability in older adults; toxicity at low serum levels; monitor thyroid and renal function

Divalproex sodium^OL*

250–2000 mg/day (therapeutic level 40–100 μg/mL)

Nausea, GI upset, ataxia, sedation

Requires monitoring of CBC, platelets, LFTs at baseline and q 6 months; better tolerated than other mood stabilizers in older patients