Bipolar depression

If not on any bipolar medication follow the formulary below

If taking lithium, check level, if it is < 1.0 mmol/L increase dose. If the level is adequate follow formulary below

If taking valproate consider increasing the dose within the therapeutic range. If the maximum tolerated dose, or the top of the therapeutic range follow formulary below

Not licensed for this indication but recommended by NICECG185

First line add 10mg to 40mg fluoxetine daily

Plasma level reduced by up to 50% by cigarette smoke

Recommended dose initially 10mg adjusted as necessary to 5 - 20mg 
  
Plasma concentration monitoring form ONLY for diagnosis of acute poisoning  

Pack Price
28 tablet £6.91
Pack Price
28 tablet £15.00
Pack Price
28 tablet £12.10
56 tablet
Pack Price
28 tablet £35.87
56 tablet
Pack Price
28 tablet £26.35
Pack Price
28 tablet £46.50
Pack Price
28 tablet £20.18
Pack Price
28 tablet £34.83
Pack Price
28 tablet £34.81
Pack Price
28 tablet £49.74
Pack Price
28 tablet £37.24
Pack Price
28 tablet £66.76
Pack Price
28 tablet £58.01
Pack Price
28 tablet £96.14

Patients can be initiated on modified release formulation but all patients should be considered for a switched to immediate release once an optimal dose is established (see policy below)

If XL is needed for clinical reasons then prescribe by branded generic: Biquelle® XL, Zaluron® XL, Sondate® XL and Mintreleq® XL have the lowest cost. N.B In East Kent GPs are being advised to switch to Sondate® XL 

Cost effective use of quetiapine

Plasma concentration monitoring form ONLY for diagnosis of acute poisoning

Pack Price
30 tablet
6 tablet
60 tablet £13.84
Pack Price
2 tablet
60 tablet £52.22
Pack Price
2 tablet
60 tablet £61.75
Pack Price
60 tablet £51.30
Pack Price
60 tablet £73.45
Pack Price
60 tablet £67.66
Pack Price
60 tablet £113.10
Pack Price
60 tablet £113.10
Pack Price
60 tablet £170.00
Pack Price
60 tablet £226.20
Pack Price
14 tablet
21 tablet
30 tablet
42 tablet
56 tablet £1.11
60 tablet
Pack Price
14 tablet
30 tablet
42 tablet
56 tablet £1.41
Pack Price
30 tablet
56 tablet £1.49
Pack Price
30 tablet
56 tablet £2.44
Pack Price
28 tablet £6.03
30 tablet
56 tablet
Pack Price
28 tablet
30 tablet
56 tablet £1.84
Pack Price
56 tablet
Pack Price
30 tablet
56 tablet £3.30

Not licensed for this indication but recommended by NICECG185

Plasma level reduced by up to 50% by cigarette smoke

Recommended dose initially 10ng adjusted as necessary to 5 - 20mg 
  
Plasma concentration monitoring form ONLY for diagnosis of acute poisoning  

Pack Price
28 tablet £6.91
Pack Price
28 tablet £15.00
Pack Price
28 tablet £12.10
56 tablet
Pack Price
28 tablet £35.87
56 tablet
Pack Price
28 tablet £26.35
Pack Price
28 tablet £46.50
Pack Price
28 tablet £20.18
Pack Price
28 tablet £34.83
Pack Price
28 tablet £34.81
Pack Price
28 tablet £49.74
Pack Price
28 tablet £37.24
Pack Price
28 tablet £66.76
Pack Price
28 tablet £58.01
Pack Price
28 tablet £96.14

Do not offer valproate to girls or young women of childbearing potential. If use cannot be avoided discuss risks and ensure that adequate contraception is being used.

Valproate medicines (Epilim▼, Depakote▼) are contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met. Use materials provided by MHRA (see link above)

Not licenced for this indication but the Maudsley Prescribing Guidelines in Psychiatry (12th edition)
   
KMPT Protocol for using valproate in women of childbearing potential                  
Medicines related to valproate: risk of abnormal pregnancy outcomes 

Valproate annual risk acknowledgement form
 

Pack Price
100 tablet £5.60
Pack Price
100 tablet £4.21
Pack Price
100 tablet £7.29
Pack Price
100 capsule
Pack Price
100 tablet £11.65
Pack Price
100 tablet £17.47
Pack Price
100 capsule £13.00
Pack Price
100 tablet £29.10
Pack Price
300 ml £9.33
Pack Price
300 ml £4.16
Pack Price
30 sachet £30.00
Pack Price
30 sachet
Pack Price
30 sachet £30.00
Pack Price
100 sachet £21.00
30 sachet £30.00
Pack Price
30 sachet £30.00
Pack Price
100 sachet £41.00
30 sachet £30.00

Do not offer valproate to girls or young women of childbearing potential. If use cannot be avoided discuss risks and ensure that adequate contraception is being used.

Valproate medicines (Epilim▼, Depakote▼) are contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met. Use materials provided by MHRA (see link above)

Not licenced for this indication but the Maudsley Prescribing Guidelines in Psychiatry (12th edition) 
   
KMPT Protocol for using valproate in women of childbearing potential          
Medicines related to valproate: risk of abnormal pregnancy outcomes 

Valproate annual risk acknowledgement form
 

Pack Price
100 capsule
Pack Price
100 capsule
Pack Price
100 capsule
Pack Price
90 tablet £17.08
Pack Price
90 tablet £34.11

Can be used in combination with an SSRI for short term treatment of bipolar depression

Usually takes at least a week to achieve therapeutic response

Lithium level must be measured weekly until stable, then 3 monthly for the first year and a minimum of six monthly thereafter

Calcium, thyroid and renal function must be monitored every 6 months.

Ensure patient has a Lithium information record card

KMPT lithium policy

NPSA Safer lithium therapy 

Shared Care Guidelines for Lithium

NB There is a shortage of liquid Priadel which is expected to last until at least mid August 2018.  For information on alternatives please see the SPS advice

Pack Price
100 tablet £2.76
Pack Price
100 tablet £4.02

Lithium citrate tetrahydrate 509mg = 200mg lithium carbonate

This is a twice daily preparation

Can be used in combination with an SSRI for short term treatment of bipolar depression

Usually takes at least a week to achieve therapeutic response

Ensure patient has a Lithium information record card

Lithium level must be measured weekly until stable, then 3 monthly for the first year and a minimum of six monthly thereafter

Calcium, thyroid and renal function must be monitored every 6 months.

KMPT lithium policy

NPSA Safer lithium therapy 

Shared Care Guidelines for Lithium

Pack Price
150 ml £6.73

Unlicensed for this indication but recommended by Maudsley

Some CCGs have not approved lurasidone for use, therefore it must not be assumed that GPs will continue the prescription. Please contact the GP. The East Kent Prescribing Group have not commissioned lurasidone for use by GPs.

Guideline for prescribing and named patient request form

Pack Price
28 tablet £90.72
Pack Price
28 tablet £90.72
Pack Price
28 tablet £90.72