Assessment

Seizures

• Assess location, duration, and characteristics of seizure activity. Institute seizure precautions

• Assess mood, ideation, and behavior frequently

• Monitor frequency of migraine headaches

• Geri: Assess geriatric patients for excessive somnolence

• Monitor CBC, platelet count, and bleeding time prior to and periodically during therapy. May cause leukopenia and thrombocytopenia

» Monitor hepatic function (LDH, AST, ALT, and bilirubin) and serum ammonia concentrations prior to and periodically during therapy. May cause hepatotoxicity; monitor closely, especially during initial 6 mo of therapy; fatalities have occurred. Therapy should be discontinued if hyperammonemia occurs

» May interfere with accuracy of thyroid function tests

» May cause false-positive results in urine ketone tests

• Therapeutic serum levels range from 50–100 mcg/ml (50–125 mcg/ml for mania). Doses are gradually until a predose serum concentration of at least 50 mcg/ml is reached. However, a good correlation among daily dose, serum level, and therapeutic effects has not been established. Patients receiving near the maximum recommended 60 mg/kg/day should be monitored for toxicity

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