Bipolar Prophylaxis

Combinations of mood stabilisers or a mood stabiliser and an antipsychotic are often required

There is evidence that where combination treatments are effective in mania or depression then continuation with the same combination provides optimal prophylaxis

Patients should be offered continuation with medications that were effective during a manic or depressive phase or a switch to lithium

Aim for plasma level of 0.4-0.8 mmol/L

Sometimes poorly tolerated at higher plasma levels, can worsen prognosis if not taken regularly

Can be combined with valproate if monotherapy is ineffective, however not in women of child-bearing potential

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

Aim for plasma level of 0.4-0.8 mmol/L

Sometimes poorly tolerated at higher plasma levels, can worsen prognosis if not taken regularly

Can be combined with valproate if monotherapy is ineffective, however not in women of child-bearing potential

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

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

Pack Price
150 ml £6.73
Pack Price
28 tablet £1.12
Pack Price
28 tablet £1.18
Pack Price
28 tablet £1.29
Pack Price
28 tablet £11.09
Pack Price
28 tablet £78.06
Pack Price
28 tablet £78.06
Pack Price
150 ml £100.72

Protects against mania and depression

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

Protects against mania and depression

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

If effective during an acute episode

Pack Price
20 tablet £0.59
Pack Price
20 tablet £0.61
6 tablet
60 tablet
Pack Price
60 tablet £1.28
Pack Price
20 tablet
60 tablet £1.55
Pack Price
20 tablet
60 tablet £1.72
Pack Price
28 tablet £3.04
30 tablet
60 tablet
Pack Price
100 ml £4.10
Pack Price
28 tablet £23.86
Pack Price
28 tablet £24.02
Pack Price
28 tablet £44.43
Pack Price
28 tablet £43.49
Pack Price
28 tablet £50.35
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

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 licensed for this indication but recommended by The Maudsley Prescribing Guidelines in Psychiatry (12th edition) and NICE CG185 
   
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 licensed for this indication but recommended by The Maudsley Prescribing Guidelines in Psychiatry (12th edition) and NICE CG185  
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

Not licensed for this indication but approved for use by the trust if a patient has had an effective response to oral aripiprazole

For initiation by specialists

Guidelines for the use of aripiprazole long-acting injection and named patient request form       

Pack Price
1 vial

Restricted to initiation by specialists

If effective during a manic episode

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

Not licensed for this indication but approved for use by the trust

For initiation by specialists

Guidelines for the use of paliperidone palmitate injection & named patient approval form    

Pack Price
1 pre-filled disposable injection
Pack Price
1 pre-filled disposable injection
Pack Price
1 pre-filled disposable injection
Pack Price
1 pre-filled disposable injection