4.2.3 Drugs used for mania and hypomania

Drugs used for bipolar disorders listed elsewhere:

Carbamazepine

  • Refer to section 4.8.1
  • 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

Lithium carbonate
  • Priadel® M/R tablet 200mg, 400mg (£2.25 = 800mg daily)

Indications

Notes

  1. Please refer to the Shared Care Guideline
Lithium citrate
  • Priadel®SF syrup 520mg (equivalent to 5.4mmol Li+) in 5ml (£5.61 = 150ml)

Indications

Notes:

  1. 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)
  2. Please refer to the Shared Care Guideline
Valproic Acid
  • Tablets 250mg, 500mg (£34.11 = 500mg x 90 tablets)

Indications

Notes

  1. Sodium valproate is not licensed for this indication.
  2. MHRA Drug Safety Update (February 2016): Valproate and risk of abnormal pregnancy outcomes: new communication materials. MHRA Drug Safety Update (April 2017): Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures.
    1. ensure women and girls taking valproate medicines understand the 30–40% risk of neurodevelopmental disorders and 10% risk of birth defects and are using effective contraception
    2. valproate should not be prescribed to female children, female adolescents, women of childbearing potential or pregnant women unless other treatments are ineffective or not tolerated; migraine is not a licensed indication
    3. valproate use in women and girls of childbearing potential must be initiated and supervised by a specialist experienced in managing epilepsy or bipolar disorder
    4. carefully balance the benefits of valproate treatment against the risks when prescribing valproate for the first time, at routine treatment reviews, when a female child reaches puberty and when a woman plans a pregnancy or becomes pregnant
    5. you must ensure that all female patients are informed of and understand:
      1. risks associated with valproate during pregnancy
      2. need to use effective contraception
      3. need for regular review of treatment
      4. the need to rapidly consult if she is planning a pregnancy or becomes pregnant
  3. Patient Safety Alert to further highlight risks to the unborn child and support the safety of girls and women taking valproate
  4. The Medicines and Healthcare Products Regulatory Agency's (MHRA) Toolkit on the risks of valproate medicines in female patients , provides resources to ensure female patients are better informed about the risks of taking valproate medicines during pregnancy.

 

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