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
Lithium treatment care pathway (to be completed before requesting GPs to prescribe
| 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
Lithium treatment care pathway (to be completed before requesting GPs to prescribe
| Pack | Price |
|---|---|
| 150 ml | £6.73 |
If effective during an acute episode
Prescribers are reminded to be alert to the risk of addictive gambling and other impulse control disorders. It is important to advise patients, their families and friends to be alert to these risks.
Plasma concentration monitoring form ONLY for diagnosis of acute poisoning
| 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 valproate guideMedicines 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 licensed for this indication but recommended by The Maudsley Prescribing Guidelines in Psychiatry (12th edition) and NICE CG185 KMPT valproate guideMedicines 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 |
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
Prescribers are reminded to be alert to the risk of addictive gambling and other impulse control disorders. It is important to advise patients, their families and friends to be alert to these risks.
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 |
Restricted to initiation by specialists
Not licensed for this indication but approved for use by the trust
| Pack | Price |
|---|---|
| 1 vial |
| Pack | Price |
|---|---|
| 1 vial |
| Pack | Price |
|---|---|
| 1 vial |
| Pack | Price |
|---|---|
| 1 pre-filled disposable injection | £285.52 |
| Pack | Price |
|---|---|
| 1 pre-filled disposable injection | £222.64 |