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Another bipolar

Nov 22, 2005

Dr Ewald-

I am HIV+, bipolar and a drug addict (clean for 8 years).On a previous e-mail, I have mentioned that my liver enzymes were 5 times higher (TGO) than it supposed to be with Tegretol use. The incident lasted one week, and other symptons were a bad rash, fever and weakeness. Does that can harm my liver and impact my future med options?

I also have a second question to you. Is starting threatment with Sustiva + Combivir a bad option if your are bipolar or can it be manageable ?

Right now I am doing lithium and a small dose of Seroquel and I am doing good with it, thanks to your previous advice.

Response from Dr. Horwath

The reaction that you described - elevated liver enzymes, rash, fever - are side effects of the Tegretol. You should be off this drug.

Lithium and Seroquel are great drugs for the management of bipolare disorder, and I'm happy to hear that you are doing well with them.

Sustiva may be a problem for you. Some people develop depression or mood swings in response to Sustiva. You may be at higher risk for this given your bipolar diagnosis. You should speak to your doctor about this. If all other factors are equal, you might be a better candidate for Viramune because it has no risk of aggravating your bipolar disorder. It is, however, associated with a risk of liver toxicity. You should discuss the pros and cons of these 2 medications with your HIV doctor.

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