Drugs used for bipolar disorders listed elsewhere:
Carbamazepine
Different brands of lithium are not equivalent. Please specify the brand when prescribing to ensure that the patient receives the same preparation.
Please ensure that the patient has a patient booklet and that the current dose, lithium levels and blood test results are completed
Priadel modified-release
(Lithium carbonate)
- Modified-release tablet 200mg, 400mg (£10.42 = 800mg daily)
Indications
Notes
- Prescribe by brand. Lithium has a narrow therapeutic index and preparations vary widely in bioavailability; changing the preparation requires the same precautions as initiation of treatment.
- Care should be taken when switching between tablet and liquid formulations of lithium as there are different dosing requirements (e.g. twice daily for liquids).
- Refer to individual shared care guidelines.
Priadel liquid
(Lithium citrate)
- Liquid sugar free 520mg/5ml (equivalent to 5.4mmol Li+) (£12.11 = 150ml)
Indications
Notes
- Prescribe by brand. Lithium has a narrow therapeutic index and preparations vary widely in bioavailability; changing the preparation requires the same precautions as initiation of treatment.
- Care should be taken when switching between tablet and liquid formulations of lithium as there are different dosing requirements (e.g. twice daily for liquids).
- Refer to individual shared care guidelines.
Valproic acid
- Depakote gastro-resistant tablets 250mg, 500mg (£11.37 = 500mg x 30 tablets)
Indications
- Treatment of manic episodes associated with bipolar disorder. It may be useful in patients unresponsive to lithium.
Notes
- MHRA Drug Safety Update (January 2024): Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell): new safety and educational materials to support regulatory measures in men and women under 55 years of age
- Refer to Oral valproate-containing medicines: safety measures for guidance from the Valproate Healthcare Professional Guide (Actions for specialist prescribers; Actions for GPs; Pregnancy Prevention Programme), contraception for patients receiving valproate, weblinks to safety materials, and supporting clinical guidance.
- Additional advice for men receiving valproate was issued in September 2024 (see note 2).
- MHRA Drug Safety Update (September 2024): Valproate use in men: as a precaution, men and their partners should use effective contraception
- A retrospective observational study has indicated a possible association between valproate use by men around the time of conception and an increased risk of neurodevelopmental disorders in their children.
- Inform male patients (of any age) who may father children of the possible risk at initiation of valproate or at their next regular treatment review – this counselling should be given irrespective of the indication for valproate and also after intravenous use of valproate.
- As a precaution, recommend that male patients use effective contraception (condoms, plus contraception used by the female sexual partner) throughout the valproate treatment period and for 3 months after stopping valproate, to allow for one completed sperm cycle not exposed to valproate.
- At the next regular treatment review, discuss with men on oral valproate treatment whether they are planning a family in the next year and if they are, refer to a specialist to discuss alternative treatment options.
- If a female patient reports they are pregnant or planning a pregnancy with a man on valproate (including those undergoing IVF), refer for prenatal counselling.
- Advise men not to donate sperm during valproate treatment and for 3 months after stopping valproate.
- Refer to the Drug Safety Update for advice and information to give to patients including an information leaflet for patients and a visual risk communication diagram for use by healthcare professionals when counselling patients.
- See resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation.