Table 3.
Recommended Dosage Adjustments for Patients with Comorbid Hepatic and Renal Disease
| Drug + | Hepatic Disease | Renal Disease |
| Lithium * | May need to increase dose with ascites due to fluid shifts | Contraindicated in Acute Renal Failure. HD dosing: 300–600 mg in singe post-HD dose |
| Valproate * | Reduce dose with elevated transaminases | None |
| Carbamazepine | Reduce dose with elevated transaminases | Reduce dose with symptoms of toxicity due to reduced clearance of toxic metabolite |
| Olanzapine * | None | None |
| Risperidone * | May need to reduce dose | Reduce dose by 50–60% due to diminished clearance |
| Quetiapine * | May need to reduce dose | None |
| Ziprasidone | None | Use intramuscular formulation with caution |
| Lamotrigine * | May need to reduce dose due to prolonged half-life | May need to reduce dose |
| Gabapentin | None | Dose reduction proportional to rise in creatinine |
| Topiramate | May need to reduce dose as clearance of drug may be decreased | Reduce dose by half |
HD = hemodialysis + Not all agents are appropriate for monotherapy. Inclusion in this table does not necessarily imply efficacy. * Currently FDA approved for use in Bipolar Disorder.