Patients with bipolar disorder (BD) have a higher inherent risk to develop kidney and liver diseases, a risk that is further exacerbated by the medications used in BD treatment. Kidney and liver impairment not only changes the pharmacokinetics of medications used in BD treatment but also predicts higher morbidity and mortality in these patients. Patients with BD and chronic kidney disease using lithium, oxcarbazepine, paliperidone, risperidone, clozapine, lurasidone, bupropion, or venlafaxine should have their doses adjusted according to glomerular filtration. Patients with BD and chronic liver disease using valproate, lamotrigine, quetiapine, risperidone, olanzapine, clozapine, sertraline, venlafaxine, bupropion, and fluoxetine should have their doses adjusted according to the severity of liver impairment. Little to no data is available on the usage of cariprazine in patients with severe kidney impairment, as well as on the usage of oxcarbazepine, asenapine, paliperidone, cariprazine, ziprasidone, and haloperidol in patients with severe liver impairment. Lithium’s role in developing chronic kidney disease is well established, as well as clozapine’s role in developing acute renal failure. Valproate, carbamazepine, quetiapine, risperidone, olanzapine, haloperidol, and clozapine are involved in the development of asymptomatic liver enzyme elevations, as well as acute liver injury rarely.