Drugs used for bipolar disorders listed elsewhere:

Carbamazepine

• Refer to section 4.8.1 Control of the epilepsies
• May be used under specialist supervision for the prophylaxis of bi-polar disorder in patients unresponsive to other drugs.

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 (£7.91 = 800mg daily)

Indications

• Acute episodes of mania or hypomania
• Prophylaxis of recurrent bipolar disorder
• Recurrent depressive episodes (where treatment with other antidepressants has been unsuccessful)

Notes

1. 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.
2. 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)
3. Refer to individual shared care guidelines

Priadel liquid

(Lithium citrate)

• Liquid sugar free 520mg/5ml (equivalent to 5.4mmol Li+) (£11.18 = 150ml)

Indications

• Acute episodes of mania or hypomania
• Prophylaxis of recurrent bipolar disorder
• Recurrent depressive episodes (where treatment with other antidepressants has been unsuccessful)

Notes

1. 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.
2. 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)
3. 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

1. Specific information to support adherence to the Valproate Pregnancy Prevention Programme during the COVID-19 pandemic can be found here.
2. MHRA Drug Safety Update (April 2018): Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met and only if other treatments are ineffective or not tolerated, as judged by an experienced specialist
   1. GPs must identify and recall all women and girls who may be of childbearing potential, provide the Patient Guide and check they have been reviewed by a specialist in the last year and are on highly effective contraception
   2. Specialists must book in review appointments at least annually with women and girls under the Pregnancy Prevention Programme and re-evaluate treatment as necessary; explain clearly the conditions as outlined in the supporting materials; and complete and sign the Risk Acknowledgement Form — copies of the form must be given to the patient or patient/caregiver/responsible person and sent to their GP
   3. Use of valproate in pregnancy is contraindicated for bipolar disorder and must only be considered for epilepsy if there is no suitable alternative treatment
3. The Medicines and Healthcare Products Regulatory Agency's (MHRA) Toolkit (Pregnancy Prevention Programme) on the risks of valproate medicines in female patients, provides resources to ensure female patients are better informed about the risks of taking valproate medicines during pregnancy
4. See resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation