The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the Editor

Editor, – Gin Malhi, Michelle Tanious, Danielle Bargh, Pritha Das and Michael Berk have provided an excellent article on the safe and effective use of lithium (Aust Prescr 2013;36:18–21). They make reference to a ‘sustained slow-release formulation which may be better tolerated by some patients’. Only two of four lithium-containing compounds listed in MIMS are suitable for lithium treatment. These are lithium carbonate and are listed as Lithicarb and Quilonum SR. Lithicarb in a new gluten-free formulation is not sustained release. Quilonum SR is commonly believed to be a sustained-release preparation, but it is not. The manufacturer states ‘While Quilonum SR tablets are designed to reduce fluctuations in plasma lithium concentrations, the formulation is not prolonged release in the usual sense’. Lithicarb is a 250 mg scored tablet readily permitting fine tuning of dose, but normally given twice a day. Quilonum SR tablets should be given every 12 hours as detailed in the product information. The 450 mg preparation may be suitable for many patients, but the larger dose means finetuning the dose may be difficult. At present we have no sustained-release lithium preparation in Australia.

John Tiller
Professor of Psychiatry
Albert Road Clinic

Author's comments

Gin Malhi, an author of the article, comments:

We are grateful to Professor Tiller for pointing out the lack of availability of a sustained-release lithium preparation in Australia. This underscores our primary concern that lithium is being ‘forgotten’ and that because of its declining use clinical experience is being lost. A key reason for this is its relatively modest promotion by pharmaceutical companies, possibly explaining the limited variety of formulations that are available.

Therefore coupled with exaggerated concerns regarding its safety profile, it is perhaps not surprising that lithium is prescribed less than other treatments. However, it is important to reiterate that lithium remains the gold standard among mood stabilisers for bipolar disorder and that in addition to its prophylactic effects with respect to mood, it is also antisuicidal and neuroprotective.