NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Lithium (Priadel 200mg Tablets): Stock Shortage

Sanofi, the manufacturers of Priadel tablets, have issued notice that there is a supply problem with Priadel 200mg Tablets. There is no indication of when this will be resolved. Priadel 400mg Tablets and Priadel Liquid preparations are unaffected. However as Priadel liquid is a different salt from the tablets, direct switching is not possible and not recommended.

 

The NHSGGC Prescribing Management Group - Mental Health has issued this advice on how to manage patients who are currently using Priadel 200mg Tablets.

Patients prescribed a 200mg dose.

 

Although described as modified release, Priadel 400mg tablets are scored and can be halved to give a 200mg dose. It may be prudent to check the patient’s lithium level one week after starting using halved tablets.

 

Patients prescribed a Priadel dose that is not a multiple of 200mg, eg 300mg, 500mg, or 700mg

 

  • Take a reference lithium level if one not available within the last 2 weeks
  • If the result is below 0.6mg/L, round the dose up to 400mg, 600mg or 800mg and repeat the lithium level after 7 days. Adjust the dose as necessary thereafter.
  • If the result is above 0.8mg/L, round the dose down to 200mg, 400mg or 600mg and repeat the lithium level after 7 days. Adjust the dose as necessary thereafter.
  • If the result is within 0.6 – 0.8mg/L, alter the dose as appropriate with consideration of the patient’s clinical presentation.

 

Please note the proportional change in lithium levels of implementing this approach for patients on lower doses of Priadel, eg 300mg may be greater. Such patients may require particularly close monitoring.

 

For any patients with impaired renal function it would be prudent to seek the advice of NHSGGC mental health services before making any dosage alterations.

 

In all circumstances consider the patient’s overall clinical presentation. If necessary contact NHSGGC Mental Health Services for advice.