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The Royal Pharmaceutical Society (RPS) has said it is ”deeply concerned” and warned of the “huge extra cost” to the NHS after a manufacturer announced plans to discontinue production of one of its branded lithium carbonate products.
In August 2020, Essential Pharma said it would be discontinuing production of Priadel 200mg and 400mg — used as a first-line treatment for bipolar disorder — in April 2021 “due to restrictions on permitted pricing”, making the product “no longer viable”.
In a supply disruption alert, the Department of Health and Social Care (DHSC) advised prescribers to switch patients to one of three alternatives: Camcolit 400mg, Liskonum 450mg or Essential Pharma’s generic lithium carbonate 250mg — all of which cost more than the Priadel products.
Priadel 400mg and 200mg are currently priced at £4.02 and £2.76 per pack of 100, respectively. Meanwhile, Camcolit 400mg – which is also owned by Essential Pharma — costs £48.18 per pack of 100 and Essential Pharma’s generic lithium carbonate 250mg costs £87 per pack of 100. The manufacturer’s generic product was previously branded as Camcolit 250mg until 2015.
The other suggested alternative to Priadel — Liskonum — is manufactured by Teopharma and costs £11.84 per pack of 100.
Claire Anderson, chair of the RPS English Pharmacy Board, said the discontinuation “is deeply concerning for those who use lithium on a regular and well-managed basis,” adding that it “will come as a huge extra cost to the NHS”.
“This is not as simple as switching brands; different products can produce different responses for different people. The latest RPS policy on mental health care states that patients should get the best support and access to safe and effective medicines. They should not be in a position where they go without them,” she said.
Anderson added that the RPS will be “raising this at our next meeting with the DHSC and CMA [Competition and Markets Authority] as we search for urgent clarification on the availability of these medicines”.
When switching patients from Priadel to an alternative brand, Steve Bazire, a fellow of the College of Mental Health Pharmacists and author of the Psychotropic Drug Directory textbook, said: “The obvious thing is to go from Priadel to Camcolit.”
“One of the problems is that, historically, people think there is a difference between the lithium preparations, but between Camcolit and Priadel there is no difference,” he said, adding that because “we know Camcolit (the Essential Pharma 250mg tablets have a different name but still have Camcolit on the tablets) is identical to Priadel, that’s what we can recommend, albeit with a higher price”.
The DHSC said in the initial alert that “patients must be maintained on the same brand of lithium to ensure that a consistent serum lithium level is maintained,” with the switching necessitated by the discontinuation requiring “individualised determination of dose, close monitoring of serum lithium levels and vigilance for relapse and tolerability in all cases”.
A DHSC spokesperson said: “We have been in discussion with Essential Pharma on pricing for Priadel and it is disappointing they have chosen not to continue these discussions. Alternative lithium products will remain available.
“We understand the importance of carefully managing any changes to a patient’s treatment and have worked with national mental health experts to issue guidance for healthcare professionals to support those affected.”
In a statement, Essential Pharma said that discontinuing the supply of Priadel was a “difficult decision”.
“We have sought to minimise disruption to patients and to allow time for the transfer to suitable alternative lithium products by providing the Department of Health with an extended notice period of such discontinuance,” it said.
“The Department of Health and the Royal College of Psychiatrists are developing relevant guidelines for healthcare professionals and patients to aid such transition and we will ensure that sufficient supply of Priadel remains available until 6 April 2021 to match local demand for the product until such date.”
