Manchester LPC warns pharmacists about local lithium prescribing incidents
Local incidents involving lithium prescriptions have prompted Greater Manchester local pharmaceutical committee (LPC) to remind pharmacists of good practice and the right protocols to follow.
On one occasion, a patient was switched from Priadel liquid to tablets, the LPC wrote in an update on its website earlier this week (August 8).
“The prescribed dose was not equivalent, lithium monitoring did not take place and carers were advised to crush the tablets,” it added.
Meanwhile, another episode saw a patient overdosing on their lithium after both Priadel and Camcolit tablets were requested and given to the patient.
LPC chief executive officer Luvjit Kandula told C+D that the specifics of the incidents were not disclosed to the committee for confidentiality reasons, so it is unclear in which setting or where the incidents took place.
“However, we all felt it is sensible to raise the safety alert to ensure all healthcare professionals are made aware of the incident to avoid this in future,” she noted.
The LPC works closely with Greater Manchester’s integrated care system “to ensure patient safety is at the forefront of our focus at all times across health and social care”, Ms Kandula said.
What to be aware of when handling lithium requests
Lithium carbonate is supplied in tablet form – and these should not be crushed or chewed – while lithium citrate is available in liquid form, the LPC clarified.
“A lack of clarity over which preparation is intended can lead to a patient receiving a subtherapeutic or toxic dose. Changing the preparation requires the same precautions as initiation of treatment,” it wrote.
It therefore invited pharmacists in the area to check lithium is prescribed as per the Greater Manchester Medicines Management Group’s shared care protocol and ensure it is always dispensed by brand name.
“Always be clear in the patient records or medicines administration record what preparation the patient is receiving,” the LPC advised.
Pharmacists should also check interactions when dispensing new medicines and check that the patient receives regular monitoring of lithium levels at least every three months. Patients' bloods – including a thyroid function test, urea and electrolytes test and monitoring calcium levels – every six months.
What are the key counselling points for patients collecting lithium? Complete this CPD module on the C+D Community
