netFormulary NHS
Cambridgeshire and Peterborough
Formulary
 Search
 Formulary Chapter 4: Central nervous system - Full Chapter
Chapter Links...
 Details...
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 (Priadel)
(Modified release (MR) tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Amber SCG
  •  200mg MR tablet (5.4mmol Li+) + 400mg MR tablet (10.8mmol Li+)


October 2020: Priadel stock availability

  • Essential Pharma has confirmed that the monthly quotas in place at AAH, Alliance & Phoenix will remain to ensure continued supply. The quotas refresh at the start of each month. 
  • If emergency stock above these quotas are required before quotas are refreshed (on the 1st of each month), pharmacies and dispensing practices are requested to contact their wholesalers’ customer services first. If wholesalers are out of stock pharmacies / dispensing practices can place emergency orders directly with Movianto UK:
  • SKU’s to quote when ordering:
    • Priadel 200mg Tablets – PRI200TUK
    • Priadel 400mg Tablets – PRI400TUK
    • Priadel Liquid - PRI150L
 
Lithium Citrate (Li-Liquid)
(Oral solution)
View adult BNF View SPC online View childrens BNF  Track Changes
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)
View adult BNF View SPC online View childrens BNF  Track Changes
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  (Camcolit)
(Modified release (MR) tablet)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Amber SCG

 

    • Requires specialist initiation by mental health team. This brand of lithium should not be prescribed for new initiations.
    • Priadel is the preferred brand of lithium.
    • 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.
    • 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 Carbonate  (Liskonum)
(Modified release (MR) tablet)

View adult BNF View SPC online View childrens BNF Track Changes
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+)
    • 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 Carbonate  (Lithium Carbonate Essential Pharma )
(Immediate release tablet)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Amber No SCG

 

    • Requires specialist initiation by mental health team. This brand shold not be used for any new initiations.
    • Priadel is the preferred brand of lithium.
    • 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
 
  
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).  

netFormulary