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 valproate guide Medicines related to valproate: risk of abnormal pregnancy outcomes
| 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 valproate guide Medicines related to valproate: risk of abnormal pregnancy outcomes
| 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
Lithium treatment care pathway (to be completed before requesting GPs to prescribe
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.
Lithium treatment care pathway (to be completed before requesting GPs to prescribe
| 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.
| Pack | Price |
|---|---|
| 28 tablet | £90.72 |
| Pack | Price |
|---|---|
| 28 tablet | £90.72 |
| Pack | Price |
|---|---|
| 28 tablet | £90.72 |