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. 2023 Apr;47(2):71-76.
doi: 10.1192/bjb.2021.126.

Plus ça change? Switching lithium preparations

David A Cousins  1   2 , Thomas R E Barnes  3   4 , Allan H Young  5   6 , Oriana Delgado  4 , Carol Paton  3   4
Affiliations

Plus ça change? Switching lithium preparations

David A Cousins et al. BJPsych Bull. 2023 Apr.

Abstract

Aims and method: A supply disruption alert in 2020, now rescinded, notified UK prescribers of the planned discontinuation of Priadel® (lithium carbonate) tablets.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.

Results: 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.

Clinical implications: 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.

Keywords: Camcolit; Priadel; adherence; plasma lithium levels; switch.

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Conflict of interest statement

D.A.C. has accepted honoraria for presenting at educational events organised by Lundbeck, paid to his main employer Newcastle University. A.H.Y. has delivered paid lectures and contributed to advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS; he is a consultant to Johnson & Johnson and Livanova; he has received grants as Principal Investigator for the following studies: Restore-Life VNS registry study funded by LivaNova; ESKETINTRD3004 – An Open-label, Long-term, Safety and Efficacy Study of Intranasal Esketamine in Treatment-resistant Depression; The Effects of Psilocybin on Cognitive Function in Healthy Participants; The Safety and Efficacy of Psilocybin in Participants with Treatment-Resistant Depression (P-TRD); Novartis MDD study MIJ821A12201 (as UK Chief Investigator); he has past and present grant funding from the following organisations: NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK). Janssen (UK).

Figures

Fig. 1
Fig. 1
Individual pre- and post-switch plasma lithium levels by post hoc group allocation according to dose change and adherence issue status for (a) all patients (n = 37) and (b) patients switched to Camcolit® tablets (n = 27).
See this image and copyright information in PMC

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