Drugs used for bipolar disorders listed elsewhere:

Carbamazepine

• Refer to section 4.8.1 Control of the epilepsies
• May be used under specialist supervision for the prophylaxis of bi-polar disorder in patients unresponsive to other drugs.

Different brands of lithium are not equivalent. Please specify the brand when prescribing to ensure that the patient receives the same preparation.

Please ensure that the patient has a patient booklet and that the current dose, lithium levels and blood test results are completed

Priadel modified-release

(Lithium carbonate)

• Modified-release tablets 200mg, 400mg (£10.42 = 800mg daily)

Indications

• Acute episodes of mania or hypomania
• Prophylaxis of recurrent bipolar disorder
• Recurrent depressive episodes (where treatment with other antidepressants has been unsuccessful)

Notes

1. Prescribe by brand. Lithium has a narrow therapeutic index and preparations vary widely in bioavailability; changing the preparation requires the same precautions as initiation of treatment.
2. Care should be taken when switching between tablet and liquid formulations of lithium as there are different dosing requirements (e.g. twice daily for liquids).
3. Refer to individual shared care guidelines for use in Central Nervous System conditions.

Priadel liquid

(Lithium citrate)

• Liquid sugar free 520mg/5ml (equivalent to 5.4mmol Li+) (£12.11 = 150ml)

Indications

• Acute episodes of mania or hypomania
• Prophylaxis of recurrent bipolar disorder
• Recurrent depressive episodes (where treatment with other antidepressants has been unsuccessful)

Notes:

1. Prescribe by brand. Lithium has a narrow therapeutic index and preparations vary widely in bioavailability; changing the preparation requires the same precautions as initiation of treatment.
2. Care should be taken when switching between tablet and liquid formulations of lithium as there are different dosing requirements (e.g. twice daily for liquids).
3. Refer to individual shared care guidelines for use in Central Nervous System conditions.

Valproic acid

• Gastro-resistant tablets 250mg, 500mg (£11.37 = 500mg x 30 tablets)

Indications

• Treatment of manic episodes associated with bipolar disorder

Notes

1. MHRA Drug Safety Update (January 2024): Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell): new safety and educational materials to support regulatory measures in men and women under 55 years of age
   1. Refer to Oral valproate-containing medicines: safety measures for guidance from the Valproate Healthcare Professional Guide (Actions for specialist prescribers; Actions for GPs; Pregnancy Prevention Programme), contraception for patients receiving valproate, weblinks to safety materials, and supporting clinical guidance.
   2. Additional advice for men receiving valproate was issued in September 2024 (see note 2 below).
2. MHRA Drug Safety Update (September 2024): Valproate use in men: as a precaution, men and their partners should use effective contraception
   1. A retrospective observational study has indicated a possible association between valproate use by men around the time of conception and an increased risk of neurodevelopmental disorders in their children.
   2. Inform male patients (of any age) who may father children of the possible risk at initiation of valproate or at their next regular treatment review – this counselling should be given irrespective of the indication for valproate and also after intravenous use of valproate
   3. As a precaution, recommend that male patients use effective contraception (condoms, plus contraception used by the female sexual partner) throughout the valproate treatment period and for 3 months after stopping valproate, to allow for one completed sperm cycle not exposed to valproate
   4. At the next regular treatment review, discuss with men on oral valproate treatment whether they are planning a family in the next year and if they are, refer to a specialist to discuss alternative treatment options
   5. If a female patient reports they are pregnant or planning a pregnancy with a man on valproate (including those undergoing IVF), refer for prenatal counselling.
   6. Advise men not to donate sperm during valproate treatment and for 3 months after stopping valproate.
   7. Refer to the Drug Safety Update for advice and information to give to patients including an information leaflet for patients and a visual risk communication diagram for use by healthcare professionals in counselling patients.
3. See resources for: contraception for drugs with teratogenic potential, and prescribing in pregnancy and lactation.