Bipolar disorder and mania
Drug Safety Update
April 2009: Antiepileptics adverse effects on bone (carbamazepine, phenytoin, primidone and sodium valproate)
December 2012: Carbamazepine, oxcarbazepine and eslicarbazepine potential risk of serious skin reactions
September 2018: Valproate Pregnancy Prevention Programme: actions required now from GPs, specialists, and dispensers
December 2018:Valproate medicines: are you acting in compliance with the pregnancy prevention measures?
April 2018 and May 2018 and Dec 18: Valproate medicines must no longer be used in women and girls of childbearing potential unless a Pregnancy Prevention Programme is in place. All prescribers that are initiating valproate should complete the Risk Acknowledgement Form and keep a copy in the patient's healthcare records as a permanent record of your discussion.
NPSA Safety Alert
Safer lithium therapy, December 2009
March 2019: Medicines with teratogenic potential: what is effective contraception and how often is pregnancy testing needed?
April 2019: Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
May 2020: Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19)
NICE guidance
CG185: Bipolar disorder assessment and management, September 2014
Kent and Medway NHS and Social Care Partnership (KMPT) Formulary has detailed prescribing information:
Mania and hypomania
Bipolar depression
Bipolar prophylaxis
Local shared care guidance
Shared care guidance for lithium prescribing
Antipsychotics are used in both an acute manic attack and in long term prophylaxis see links above for detailed information
Lithium:
- Monitor levels (see KMPT links above for guidance - under lithium)
- Caution with interactions - always check
- Ensure patient has a lithium information record card
Preparations vary widely in bioavailability changing the preparation requires the same precautions as initiation of treatment
| Pack | Price |
|---|---|
| 100 tablet (10 x 10 tablets) | £2.76 |
| Pack | Price |
|---|---|
| 100 tablet (10 x 10 tablets) | £4.02 |
For Priadel liquid: Lithium citrate tetrahydate 520mg (5ml) is equivalent to lithium carbonate 204mg.
For Li-Liquid: Lithium citrate tetrahydate 509mg (5ml) is equivalent to lithium carbonate 200mg.
Preparations vary widely in bioavailability changing the preparation requires the same precautions as initiation of treatment
| Pack | Price |
|---|---|
| 150 ml | £6.73 |
| Pack | Price |
|---|---|
| 90 tablet | £17.08 |
| Pack | Price |
|---|---|
| 90 tablet | £34.11 |
Unlicensed use. No longer endorsed by NICE
Use MR formulation to reduce the risk of side effects
| Pack | Price |
|---|---|
| 30 tablet | |
| 50 tablet | |
| 56 tablet | £5.20 |
| 60 tablet |
| Pack | Price |
|---|---|
| 30 tablet | |
| 50 tablet | |
| 56 tablet | £10.24 |
| 60 tablet |