Lithium - Which Brands Are Available?

[tort]

Hello,

Can anyone tell me which brands of lithium are available in Thailand? I am aware it is prescription only.

I've tried the Mimms link in the sticky but you need a username and password to use it.

Thanks

[Sheryl]

Licarb

Limed

Lit 300

Lithium Pharmaland

All locally made.

And while IMO it should be, it is not prescription only in Thailand. FDA class D.

[tort]

Thank you.

What is Class D? Pharmacist sale only?

[Sheryl]

Yes - sale by fully fledged pharmacist only & same must be on the premises at all times (enforcement of the latter is, as you might expect, problematic).

[tort]

Thanks.

Anybody know anyone who has taken any of this Thai lithium for any length of time? Would like to know how they compare to UK Priadel which is once per day. I think other brands are at least two times per day.

[Sheryl]

That's not really how it works.

Both Priadel and the Thai brands are lithium carbomate.

Priadel comes in different dosages, there is both a 200 and a 400 mg preparation.

All the Thai brands come only as 300 mg tabs.

Both Priadel and the Thai brands may be taken once, twice or several times daily depending in the dosage required and other factors.

The required dosage of lithium is highly individual. In addition, the therapeutic margin is unusually narrow, that is to say, the blood level of the drug necessary to get therapeutic results and the level which is toxic are unusually close, and lithium toxicity can be quite serious. Hence it needs to be prescribed under close medical supervision and with frequent blood tests to monitor lithium levels.

This is absolutely not something that can be safely or effectively self prescribed.

See a psychiatrist specializing in mood disorders. No need to buy the medication from the hospital pharmacy if you want to save on expenses by avoiding their mark-up, but do get professional guidance on dosing and periodic blood level checks.

Due to the above mentioned problems lithium is not so commonly used for first line treatment these days except where medication cost is a major concern, as there are newer drugs with wider therapeutic ranges and lower toxicity.

[tort]

As far as I know Priadel prolonged release is the only lithium available that is a once per day dose to maintain the desired serum lithium level of 0.6 to 1.2 mmol/litre. Toxic level being 1.5 mmol/litre hence the need for regular blood tests especially when establishing the dose required at either the onset of treatment or changing brands.

Some types are 4 times a day dosing while other types of controlled release are 2 times a day.

They're all lithium carbonate though ( except Priadel syrup which is lithium citrate )

[krading]

Eveready.

Somebody had to say it.

[deejah]

in the old days

coca cola had cocaine and 7up had lithium

there is a newer approach using lithium called micro dosing

no need for blood level checks

best to see a good doc though

what are the newer less toxic drugs?

[tort]

The only ones I know of are sodium valproate, carbamazepine and lamotrigine.

I presume by "micro-dosing" you are referring to lithium orotate?

[Sheryl]

Tort,

You are correct, I mispoke. It seems Priadel is indeed a slower release formulation and you will not find an equivalent lithium preparation in Thailand.

Assuming one is talking of Lithium as a mood stabilizer rather than anti-depressant, newer drugs include:

valproic acid (Depakote, Depakene etc -- actually not at all nerw, but newer than lithium)

risperidone (Risperdal)

oxcarbazepine (trileptal -- similiar to carbamazepine in action but lower incidence of bone marrow suppression)

lamatrigine (Lamictal))

olanzapine (Zyprexa)

quetiapine (Seroquel)

aripiprazole (Abilify)

ziprasidone (Geodon)

Note that these are not all the same in their action; all will help control manic manifestations of bipolar disease but only some also address depression. In addition to toxicity issues and potential side effects/drug interactions, the sheer range of options and the differences among them and in which patients will best respond to them are another reason why consultation with a pyschiatrist specializing in mood disorders is best.

Olanzapine and quetiapine are probably the most widely used of the newer drugs, there has been more experience and is a stronger body of research in support of olanzapine.

Fish oil supplementation has also been found helpful in long term management of BPD

http://www.psycheducation.org/depression/meds/Omega-3.htm

BPD is quite common in Thailand and Thai pyschiatrists have a lot of experience with it. The following doctor at Bumrungrad Hospitalspecializes in mood disorders and has been favorably recommended by other TV members:

Dr. Suttiporn Janenawasin . Female,comparatively young, US trained (Stanford)

Tues, Wed, fri and Sat 9 am - 4 PM

Thursdays 1 - 8 PM

[tort]

Thanks Sheryl.

Olanzapine is a miracle drug for episodes of hypomania/mania but the weight gain from it is astronomical, enough to put most people off using it long term as a prophylactic.

Expensive as well, like the other newer antipsychotics some of which you mention.

It's amazing that there hasn't been an effective bipolar preventative treatment since lithium that hasn't been "borrowed" from other illnesses eg. epilepsy, schizophrenia.

[FallsG]

Hello

I am trying to ensure that Lithium, Lamictal Paxil are available and affordable in Paxil.  Could someone please tell me the prices of these drugs?

 

Many thanks in advance

Jeff

[Sheryl]

Lithium is available in several local brands. Lamotrigine (Lamistal) has one locally made brand called Lamoga.

 

Paroxetine (Paxil) is available only in brand name Seroxat which is an expensive import.

 

Psychiatric care ius a weak point in the Thai health system. Good psychiatrists can be found in Bangkok and Chiang Mai but not much beyond that and perhaps a few large regional teaching hospitals. Keep that in mind when deciding where in Thailand you settle or visit for protracted periods.

[JSebastian]

Hello, sorry for necroposting. Anyway, is it possible to buy Priadel at a pharmacy in Pattaya?

[Sheryl]

4 hours ago, JSebastian said:

Hello, sorry for necroposting. Anyway, is it possible to buy Priadel at a pharmacy in Pattaya?

As earlier noted in this thread Priadel is not available in Thailand. 

[JSebastian]

Thanks Sheryl,

 

Any info about thai brands?

[Sheryl]

11 hours ago, JSebastian said:

Thanks Sheryl,

 

Any info about thai brands?

Thai brands are not extended release. So not interchangable with Priadel.

 

Are you taking this as a mood stabilizer or as an antidepressnt? Either way should consult a psychiatrist as to best local alternative.

[JSebastian]

On 10/2/2023 at 10:05 AM, Sheryl said:

Thai brands are not extended release. So not interchangable with Priadel.

 

Are you taking this as a mood stabilizer or as an antidepressnt? Either way should consult a psychiatrist as to best local alternative.

As an antidepressant. I am on a course of treatment remotely, with the psychotherapist with whom I was treated before arriving in Thailand. He asked me to find out what Lithium medicines are available in Pattaya. Before, I bought antidepressants at Fascino Pharmacy, but they don't have Lithium and can't be ordered.

 

[Sheryl]

3 hours ago, JSebastian said:

As an antidepressant. I am on a course of treatment remotely, with the psychotherapist with whom I was treated before arriving in Thailand. He asked me to find out what Lithium medicines are available in Pattaya. Before, I bought antidepressants at Fascino Pharmacy, but they don't have Lithium and can't be ordered.

 

Tell him only short acting lithium available here and see what he advises

[JSebastian]

1 hour ago, Sheryl said:

Tell him only short acting lithium available here and see what he advises

She said short release is ok. Any guess about pharmacies in Pattaya?

[Sheryl]

12 hours ago, JSebastian said:

She said short release is ok. Any guess about pharmacies in Pattaya?

Best try would be Fascino, main branch  on Pattaya Nua between Second Rd and Third Rd on the south side of the road. No guarantees though as this is not a widely used drug.

 

If that fails you can ask  https://medisafepharma.com/  

Use the Messenger function on the website. If they also cannto supply you will have to see a psychiatrist at a hospital - which I recommend in any case (see below)

 

Lithium has a very narrow therapeutic range and frequent blood tests are essential to avoid toxicity.  Has this been arranged for? It may be dfficult to get at a lab, you might need to have it done at a large hospital.

 

It is also an odd choice given the many newer drugs with better safety profile.  I would suggest you see a good, Western-trained psychiatrist specializing in mood disorders for a second opinion rather than continuing to rely on long distance prescribing (you can of course still continue the long distance psychotherapy). Such as

 

https://www.bumrungrad.com/en/doctors/suttiporn-janenawasin

 

US trained (Stanford university)

 

In Bangkok not Pattaya - you will not find anyone remotely of that caliber in Pattaya

 

Consultation about 2,000 baht

[JSebastian]

Thank you for such a detailed response to my message. Yes, in the Nhealth lab on Sukhumvit Road, there is an opportunity to take such tests and monitor the lithium level in the blood serum https://weblabonline.nhealth-asia.com/website/Catalog/Content?ProductCode=C670

[JSebastian]

On the second try I managed to order LICARB from Fascino. It should be noted that the order was delivered in 2 weeks.

[David Rudd]

Hi Sheryl I have been taking pridel modified release for over 30y 800mg know moving to Hua hin I understand you cannot get can you help please 

[David Rudd]

Just now, David Rudd said:

Hi Sheryl I have been taking pridel modified release for over 30y 800mg know moving to Hua hin I understand you cannot get can you help please I take sodium valpuratte Haswell both for Bi- polar

 

[Sheryl]

7 hours ago, David Rudd said:

 

 

7 hours ago, David Rudd said:

Hi Sheryl I have been taking pridel modified release for over 30y 800mg know moving to Hua hin I understand you cannot get can you help please 

 

You need to discuss with your pyschiatrist and explain to him that in Thailand only short acting forms of lithium 300 mg are available. Priadel is sustained release so not the same. Your doctor might advise to switch to a different medication or to switch to short acting lithium on a different dosage schedule. In either case, best to make the change and get stabilized on it before moving to Thailand.

 

I think you mean sodium vaproic acid not sodium valpuratte.  This is available in Thailand in both immediate and sustained release. It is essential to know exactly what dose and type you are on.

 

While these drugs in Thailand do not require a prescription, you should   be under care of a psychiatrist to monitor blood levels and adjust as needed.

 

The best source for that from Hua Hin is the government pysch hospital in Thonburi

 

https://www.somdet.go.th/

 

It will be about a 2 1/2 drive or bus ride from Hua Hin. Best to use their after hours clinic rather than public channel, the doctors are more senior and in less of a rush. 

 

 

 

 

[David Rudd]

Hi Sheryl  thank you for reply completely understand what you are saying i will explain to my doctor in uk see if I can get one of other thia brands in uk don't fancy change to another medication thanks for your help