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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.02.03  Expand sub section  Drugs used for mania and hypomania
 note 

Aripiprazole, olanzapine, quetiapine and risperidone are licensed for acute mania. Aripiprazole, olanzapine and quetiapine are licensed for the prevention of recurrence of mania. Quetiapine is also licensed for bipolar depression and the modified release formulation as an add-on treatment of major depressive episodes in patients with Major Depressive Disorder (MDD) who have had sub-optimal response to antidepressant monotherapy. 

04.02.03  Expand sub section  Benzodiazepines
04.02.03  Expand sub section  Carbamazepine
04.02.03  Expand sub section  Valproic acid
04.02.03  Expand sub section  Lithium to top
 note 

Please ensure prescribed by BRAND as brands are not interchangeable


Lithium has a narrow therapeutic range (0.4-1.0mmol/l based on a blood sample taken 12 hours after the last dose).  Regular monitoring of lithium levels is essential.  Levels should initially be checked 5-7 days after starting lithium or after a change in dose or formulation and then weekly until stable.  Thereafter levels should be monitored at three monthly intervals.

Follow Therapeutic Drug Monitoring guidelines.

Check eGFR and thyroid function (TSH) at baseline and then 6-monthly.  An ECG is recommended before initiating lithium if there are risk factors for or existing cardiovascular disease.  Ensure patient is given a purple NPSA Lithium Therapy Information Pack.  For further information refer to Local Services Safer Lithium Therapy Policy and Procedures and Primary/Secondary Care Lithium Prescribing and Monitoring Guideline.

Lithium Carbonate (Camcolit®)
(Modified release (MR) tablet)
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Restricted Drug Restricted
Amber No SCG

 

    • Requires specialist initiation by mental health team
    • Preferred brand of lithium where a 400mg modified release formulation is required for new patients
    • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.
    • 400mg MR tablet (10.8mmol Li+)
    • These tablets are scored. However, the score line is only to facilitate breaking for ease of swallowing and not to divide into equal doses.



 

 
Link  CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Link  Patient Safety Alert - Safer lithium therapy
Link  Primary Care: Lithium Prescribing Support in Affective disorders in Adults
   
Lithium Carbonate (Lithium Carbonate Essential Pharma ®)
(Immediate release tablet)
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Restricted Drug Restricted
Amber No SCG

 

    • Requires specialist initiation by mental health team
    • Preferred brand of lithium where a 250mg tablet formulation is required for new patients
    • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.
    • 250mg tablet (6.8mmol Li+)
    • These tablets are scored. However, the score line is only to facilitate breaking for ease of swallowing and not to divide into equal doses.



 

 
Link  CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Link  Patient Safety Alert - Safer lithium therapy
Link  Primary Care: Lithium Prescribing Support in Affective disorders in Adults
   
Lithium Citrate (Li-Liquid®)
(Oral solution)
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Restricted Drug Restricted
Amber No SCG

 

    • Requires specialist initiation by mental health team
    • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.
    • Oral solution 509mg (5.4mmol Li+) in 5ml and 1018mg (10.8mmol Li+) in 5ml.
    • Prescribe the liquid formulation as a twice daily dose to minimise peak plasma levels.
    • Due to the differences in bioavailability, contact either your pharmacy department or the CCG Medicines Optimisation Team for support if switching between oral formulations is required.



 

 
Link  CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Link  Patient Safety Alert - Safer lithium therapy
Link  Primary Care: Lithium Prescribing Support in Affective disorders in Adults
   
Lithium Citrate (Priadel®)
(Oral solution)
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Restricted Drug Restricted
Amber No SCG

 

    • Requires specialist initiation by mental health team
    • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.
    • Liquid 520mg (approx 5.4mmol Li+) in 5ml.
    • Prescribe the  liquid formulation as a twice daily dose to minimise peak plasma levels.
    • Due to the differences in bioavailability, contact either your pharmacy department or the CCG Medicines Optimisation Team for support if switching between oral formulations is required.

 

 
Link  CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Link  Patient Safety Alert - Safer lithium therapy
Link  Primary Care: Lithium Prescribing Support in Affective disorders in Adults
   
 ....
 Non Formulary Items
Lithium Carbonate  (Liskonum®)
(Modified release (MR) tablet)

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Non Formulary
Amber No SCG

  • Requires specialist initiation by mental health team

  • A purple NPSA Lithium Therapy Information Pack should be given to patients on initiation of lithium treatment.

  • 450mg MR tablet (12.2mmol Li+)


 

Link  CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Link  Patient Safety Alert - Safer lithium therapy
Link  Primary Care: Lithium Prescribing Support in Affective disorders in Adults
 
Lithium Carbonate  (Priadel®)
(Modified release (MR) tablet)

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Non Formulary
Switch
  •  200mg MR tablet (5.4mmol Li+) + 400mg MR tablet (10.8mmol Li+)

Discontinuation of Lithium carbonate (Priadel®) 200mg and 400mg modified release tablets. DO NOT INITIATE PRIADEL® BRAND OF LITHIUM TABLETS FOR NEW PATIENTS.

For new patients prescribe the required dose of lithium using Camcolit® 400mg modified-release tablets or lithium carbonate Essential Pharma 250mg tablets.

  • Priadel® (lithium carbonate) 200mg and 400mg modified-release tablets are being discontinued in the UK and remaining supplies of both strengths are expected to be exhausted by April 2021.
  • For existing patients: The DHSC have released a Supply Disruption Alert (published 21/08/2020 - see link below) however, Cambridgeshire and Peterborough STP are urgently working with our mental health specialists to agree a robust and safe management plan for patients currently prescribed Priadel 200mg or 400mg modified release tablets both in Primary and Secondary Care to ensure that any switch to an alternative formulation is carried out safely. We would advise that NO current changes to patient’s therapy, in relation to this discontinuation, should be made, until we release further information to you, which will be available over the coming weeks, during September 2020.

 

September 2020: Priadel stock availability

AAH, Alliance & Phoenix have put quotas in place to ensure continued supply until April 2021. The quotas refresh at the start of each month.

In the meantime pharmacies are able to order directly from the distributor Movianto.

Movianto Customer Service: +44 (0) 1234 248500

Movianto Customer Care Email:  Customercare.UK@movianto.com

SKU’s to quote when ordering:

Priadel 200mg Tablets – PRI200TUK

Priadel 400mg Tablets – PRI400TUK

Priadel Liquid - PRI150L

Link  CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Link  Patient Safety Alert - Safer lithium therapy
Link  Primary Care: Lithium Prescribing Support in Affective disorders in Adults
Link  Supply Disruption Alert: Discontinuation of Lithium carbonate (Priadel®) 200mg and 400mg modified release tablets (published 21/08/2020)
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

OTC

Available Over the Counter. Consider Self Care   

Green

Formulary - Can be prescribed in both secondary and primary care.   

Advice

Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

Amber No SCG

Formulary - Specialist initiation without shared care guidance.  

Amber SCG

Formulary - Specialist initiation with shared care guidance.  

Red Hospital

Restricted - Hospital only, not to be prescribed in primary care.  

Switch

Not recommended for prescribing. Switch to alternative cost-effective option.   

Black

Not recommended for prescribing in primary or secondary care.  

Grey

Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

Non Formulary

Non-Formulary (category under review).  

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