Bipolar disorder and mania
Drug Safety Update
February 2025: Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): review by two specialists is required for initiating valproate but not for male patients already taking valproate
September 2024: Valproate use in men: as a precaution, men and their partners should use effective contraception
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
October 2023: Valproate: dispense full packs of valproate-containing medicines
August 2023: Valproate: re-analysis of study on risks in children of men taking valproate
December 2022: Valproate: reminder of current Pregnancy Prevention Programme requirements; information on new safety measures to be introduced in the coming months
April 2019: Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
March 2019: Medicines with teratogenic potential: what is effective contraception and how often is pregnancy testing needed?
December 2018: Valproate medicines: are you acting in compliance with the pregnancy prevention measures?
September 2018: Valproate Pregnancy Prevention Programme: actions required now from GPs, specialists, and dispensers
April 2018: Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met
December 2012: Carbamazepine, oxcarbazepine and eslicarbazepine potential risk of serious skin reactions
April 2009: Antiepileptics adverse effects on bone (carbamazepine, phenytoin, primidone and sodium valproate)
NPSA Safety Alert
Safer lithium therapy, December 2009
NICE guidance
CG185: Bipolar disorder assessment and management
Kent and Medway NHS and Social Care Partnership (KMPT) Formulary has detailed prescribing information:
Mania and hypomania
Bipolar depression
Bipolar prophylaxis
Local shared care guidance
Shared care guidelines for lithium prescribing
Antipsychotics are used in both an acute manic attack and in long term prophylaxis see links above for detailed information
Lithium:
- Monitor levels (see KMPT links above for guidance - under lithium)
- Caution with interactions - always check
- Ensure patient has a lithium information record card
Preparations vary widely in bioavailability changing the preparation requires the same precautions as initiation of treatment
| Pack |
|---|
| 100 tablet (10 x 10 tablets) |
| Pack |
|---|
| 100 tablet (10 x 10 tablets) |
For Priadel liquid: Lithium citrate tetrahydate 520mg (5ml) is equivalent to lithium carbonate 204mg.
For Li-Liquid: Lithium citrate tetrahydate 509mg (5ml) is equivalent to lithium carbonate 200mg.
Preparations vary widely in bioavailability changing the preparation requires the same precautions as initiation of treatment
| Pack |
|---|
| 150 ml |
| Pack |
|---|
| 100 capsule |
| 30 capsule |
| Pack |
|---|
| 100 capsule |
| 30 capsule |
| Pack |
|---|
| 90 tablet |
| 30 tablet |
Unlicensed use. No longer endorsed by NICE
Use MR formulation to reduce the risk of side effects
| Pack |
|---|
| 30 tablet |
| 50 tablet |
| 56 tablet |
| 60 tablet |
| Pack |
|---|
| 30 tablet |
| 50 tablet |
| 56 tablet |
| 60 tablet |
- On Formulary Preferred
- On Formulary Second Line
- On Formulary Third Line
- Specialist Initiation
- Secondary Care Only
- Not Approved for Formulary