| Formulary Chapter 4: Central nervous system - Full Chapter
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| Details... |
| 04.02.03 |
Drugs used for mania and hypomania |
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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. |
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| 04.02.03 |
Benzodiazepines |
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Carbamazepine |
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Valproic acid |
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| 04.02.03 |
Lithium |
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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. |
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Lithium Carbonate (Priadel®)
(Modified release (MR) tablet)
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First Choice
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- 200mg MR tablet (5.4mmol Li+) + 400mg MR tablet (10.8mmol Li+)
January 2021: 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:
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CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Patient Safety Alert - Safer lithium therapy
Primary Care: Lithium Prescribing Support in Affective disorders in Adults
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Lithium Citrate (Li-Liquid®)
(Oral solution)
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 Restricted
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- 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.
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CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Patient Safety Alert - Safer lithium therapy
Primary Care: Lithium Prescribing Support in Affective disorders in Adults
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Lithium Citrate (Priadel®)
(Oral solution)
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Restricted
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- 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.
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CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Patient Safety Alert - Safer lithium therapy
Primary Care: Lithium Prescribing Support in Affective disorders in Adults
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| Non Formulary Items |
Lithium Carbonate (Camcolit®)
(Modified release (MR) tablet)
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Non Formulary
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- 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.
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CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Patient Safety Alert - Safer lithium therapy
Primary Care: Lithium Prescribing Support in Affective disorders in Adults
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Lithium Carbonate (Liskonum®)
(Modified release (MR) tablet)
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Non Formulary
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- 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.
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CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Patient Safety Alert - Safer lithium therapy
Primary Care: Lithium Prescribing Support in Affective disorders in Adults
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Lithium Carbonate (Lithium Carbonate Essential Pharma ®)
(Immediate release tablet)
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Non Formulary
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- 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.
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CPFT - Guidelines for the prescribing and monitoring of lithium treatment
Patient Safety Alert - Safer lithium therapy
Primary Care: Lithium Prescribing Support in Affective disorders in Adults
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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Available Over the Counter. Consider Self Care |
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Formulary - Can be prescribed in both secondary and primary care. |
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Formulary - Specialist Advice, secondary care advice provided for primary care initiation. |
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Formulary - Specialist initiation without shared care guidance. |
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Formulary - Specialist initiation with shared care guidance. |
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Restricted - Prescribing (and monitoring where applicable) to remain with the hospital or specialist service. Not to be prescribed in Primary Care |
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Not recommended for prescribing. Switch to alternative cost-effective option. |
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Not recommended for prescribing in primary or secondary care. |
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Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.
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Non-Formulary (category under review). |
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