Can You Take Uzedy 250 mg Monthly with Lithium 900 mg Daily?
Yes, you can take Uzedy (risperidone long-acting injection) 250 mg monthly in combination with lithium 900 mg daily—this combination is FDA-approved and clinically established for bipolar disorder treatment. 1, 2
FDA-Approved Combination Therapy
Risperidone (the active ingredient in Uzedy) is specifically FDA-approved for adjunctive therapy with lithium in the treatment of acute manic or mixed episodes in bipolar I disorder. 1
In controlled trials, risperidone at doses of 1-6 mg/day combined with lithium (therapeutic range 0.6-1.4 mEq/L) demonstrated superior efficacy compared to lithium alone for reducing manic symptoms. 1
The mean modal dose in these trials was 3.8 mg/day of oral risperidone, and Uzedy 250 mg monthly provides equivalent steady-state exposure to oral risperidone. 1
Clinical Evidence Supporting This Combination
Combination therapy with atypical antipsychotics and lithium is recommended as first-line treatment for severe bipolar mania and has been shown to be more effective than monotherapy in achieving mood stabilization. 3, 4
Research demonstrates that augmentation of lithium with atypical antipsychotics like risperidone is effective for long-term maintenance treatment and helps control both manic and depressive phases of bipolar disorder. 4
A nationwide Korean study found that the combination of lithium with atypical antipsychotics reduced suicide risk by 85% (HR 0.154) compared to no treatment, demonstrating significant mortality benefit. 5
Important Monitoring Requirements
Monitor lithium levels closely to maintain therapeutic range (0.6-1.4 mEq/L), as the combination does not typically require lithium dose adjustment but individual response varies. 1, 2
Watch for neurological toxicity: While the combination of haloperidol and lithium has been associated with encephalopathic syndrome, this specific concern has not been established with risperidone, though early monitoring for neurological symptoms is prudent. 2
Maintain adequate hydration and salt intake (2500-3000 mL fluid daily) as lithium excretion depends on sodium balance, and dehydration can increase lithium toxicity risk. 2
Monitor for extrapyramidal symptoms (EPS), metabolic effects (weight gain, glucose changes), and orthostatic hypotension, which are potential side effects of risperidone. 1
Common Pitfalls to Avoid
Do not discontinue lithium abruptly if side effects occur—contact your prescriber immediately if you experience diarrhea, vomiting, tremor, ataxia, drowsiness, or muscular weakness, as these are signs of lithium toxicity. 2
Avoid NSAIDs without medical supervision, as medications like ibuprofen and naproxen can significantly increase lithium levels and precipitate toxicity. 2
Be cautious with diuretics or ACE inhibitors, as these can reduce lithium clearance and increase serum levels, requiring dose adjustments. 2
Dosing Considerations
Your lithium dose of 900 mg daily is within the typical therapeutic range, but optimal dosing should be guided by serum lithium levels, not just the total daily dose. 2
Uzedy 250 mg monthly is an appropriate maintenance dose for most patients, though some may require dose adjustments based on clinical response and tolerability. 1
This combination allows for lower doses of each medication compared to monotherapy, potentially reducing side effect burden while maintaining efficacy. 6