Abstract
A supply disruption alert in 2020, now rescinded, notified UK prescribers of the planned discontinuation of Priadel® (lithium carbonate) tablets. This service evaluation explored lithium dose and plasma levels before and after the switching of lithium brands, in order to determine the interchangeability of different brands of lithium from a pharmacokinetic perspective. Data on the treatment of 37 patients switched from Priadel® tablets were analysed. Switching to Camcolit® controlled-release tablets at the same dose did not result in meaningful differences in plasma lithium levels. Dose adjustment and known or suspected poor medication adherence were associated with greater variability in plasma lithium levels on switching brands. For comparable pre- and post-switch doses in adherent patients, the most common brands of lithium carbonate appear to produce similar plasma lithium levels. British National Formulary guidance relating to switching lithium brands may be unnecessarily complex.
Highlights
The data on 37 patients were considered suitable for further descriptive analysis and the results presented relate to this subgroup
The majority of switches from Priadel® tablets were to Camcolit® 400 mg tablets and this rarely led to unexpectedly high or low post-switch plasma lithium levels
Known or suspected issues with medication adherence were present in a quarter of cases and as might be expected, pre- and post-switch plasma lithium levels appeared to vary more in these patients than in those with no known adherence issues
Summary
Five patients had been switched to lithium carbonate Essential Pharma® 250 mg tablets, with four undergoing a dose change and one remaining on the same dose. Three patients had been switched to a combination of Camcolit® 400 mg and lithium carbonate Essential Pharma® 250 mg tablets, with two undergoing a small change in dose. The dose was reduced to 500 mg (using lithium carbonate Essential Pharma® 250 mg tablets). The dose was increased: in one patient to 675 mg (using Liskonum® tablets), in another to 800 mg (using Camcolit® 400 mg tablets) and in a third patient to 650 mg by combining brands (Camcolit® 400 mg and lithium carbonate Essential Pharma® 250 mg tablets). For 8 of these 11 patients, the dose was changed on switching; 2 of these 8 patients had pre-switch plasma lithium levels outside the 0.4–1.0 mmol/L range.
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