Mania & Hypomania
Stop antidepressant treatment in all patients
If not on any bipolar medication follow 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 another mood stabiliser, ensure dose is optimal then follow the formulary below
Can be combined with lithium or valproate if response to adequate dose of monotherapy is ineffective
Baseline ECG required before treatment - assess need for further ECGs during treatment on an individual basis
| Pack | Price |
|---|---|
| 30 capsule | £1.18 |
| Pack | Price |
|---|---|
| 100 tablet | |
| 1000 tablet | |
| 28 tablet | £11.20 |
| 30 tablet |
| Pack | Price |
|---|---|
| 100 tablet | |
| 250 tablet | |
| 28 tablet | £12.34 |
| 30 tablet |
| Pack | Price |
|---|---|
| 28 tablet | £22.05 |
| Pack | Price |
|---|---|
| 100 tablet | |
| 20 tablet | |
| 28 tablet | £21.86 |
| 30 tablet | |
| 50 tablet |
| Pack | Price |
|---|---|
| 100 ml | £7.10 |
| 500 ml |
Can be combined with lithium or valproate if response to adequate dose of monotherapy is ineffective
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 |
Can be combined with lithium or valproate if response to adequate dose of monotherapy is ineffective
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)
Immediate release formulation should be used even though only the modified release formulation is licensed for this indication
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 |
Can be combined with lithium or valproate if response to adequate dose of monotherapy is ineffective
| 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 |
Can be combined with lithium or valproate if response to adequate dose of monotherapy is ineffective
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 |
Aim for plasma level of 1.0 mmol/L to treat acute episode
Can be combined with an antipsychotic if response to adequate dose of monotherapy is ineffective
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
| 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 1.0 mmol/L to treat acute episode
Can be combined with an antipsychotic if response to adequate dose of monotherapy is ineffective
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 |
Not licensed for this indication but can be used if liquid or modified release (once daily) formulation is required, otherwise use valproic acid
Can be combined with an antipsychotic if response to adequate dose of monotherapy is ineffective
Recommended dose initially 500mg modified release daily, increasing according to tolerability and response
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)
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 |
Can be combined with an antipsychotic if response to adequate dose of monotherapy is ineffective
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)
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 |
Not licensed for this indication but recommended by The Maudsley Prescribing Guidelines in Psychiatry (12th edition)
Up to 8mg/day
Can be used short term in combination with antipsychotic and / or valproate or lithium
| Pack | Price |
|---|---|
| 100 tablet | £30.74 |
| 60 tablet |
| Pack | Price |
|---|---|
| 100 tablet | £28.39 |
| 150 tablet | |
| 60 tablet |
| Pack | Price |
|---|---|
| 1 ml | |
| 150 ml |
Up to 4mg/day
Can be used short term in combination with antipsychotic and / or valproate or lithium
Short duration of action
May be preferred in patients with hepatic impairment
Risk of withdrawal symptoms is greater than with longer acting benzodiazepines
Not widely used in the community
| Pack | Price |
|---|---|
| 100 tablet | |
| 1000 tablet | |
| 28 tablet | £3.74 |
| 30 tablet | |
| 50 tablet |
| Pack | Price |
|---|---|
| 28 tablet | £8.82 |
| 30 tablet |
Anaphylactic reactions reported even on first dose, medical assistance must be available when first dose given
Can be combined with lithium or valproate if response to adequate dose of monotherapy is ineffective
| Pack | Price |
|---|---|
| 60 tablet | £102.60 |
| Pack | Price |
|---|---|
| 60 tablet | £102.60 |
Restricted to initiation by specialists
Not licensed for this indication but recommended by The Maudsley Prescribing Guidelines in Psychiatry (12th edition)
No longer endorsed by NICE
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 |
Restricted to initiation by specialist consultants only
Not licensed for this indication but recommended by The Maudsley Prescribing Guidelines in Psychiatry (12th edition) for refractory mania / bipolar disorder
Smoking reduces plasma levels by up to 50%
Please check the Summary of Product Characteristics (SPC) for information on monitoring and side effects
Always follow the trust policy for initiation in hospital or in the community (links below)
Clozapine outpatient prescription
Clozapine community initiation policy
Nicotine Replacement Therapy Guidance with advice on clozapine dose changes with changes in smoking status Plasma concentration assay request form
| Pack | Price |
|---|---|
| 100 tablet | |
| 28 tablet | |
| 500 tablet | |
| 84 tablet |
| Pack | Price |
|---|---|
| 100 tablet | |
| 28 tablet | |
| 500 tablet | |
| 84 tablet |
Denzapine liquid can be used for patients who are unable to swallow tablets or who have severe lactose intolerance
| Pack | Price |
|---|---|
| 100 ml | £39.60 |