A survey of lithium monitoring and prescribing patterns

INTRODUCTION: In the United Kingdom, guidelines for the monitoring of lithium are published in the British National Formulary. METHOD: Lithium monitoring and prescribing were retrospectively reviewed over a 6-year period in current patients of one General Adult Psychiatry team in Greater London. There were no instances of adherence to BNF guidelines at the start of treatment. RESULTS: In outpatients, 44% of subsequent monitoring intervals were longer than recommended and 10% of serum levels were above the recommended range of serum concentrations. Analysis of prescribing patterns by a senior pharmacist estimated 34% of the dose changes to have been inappropriate according to the trend of serum lithium levels. CONCLUSION: These results imply poor monitoring of patients on lithium, especially at the start of treatment. Training needs should be addressed. During lithium therapy, dose changes should be made with reference to previous serum levels. (Int J Psych Clin Pract 2000; 4:135-138).