Madison Clinic
For Providers For Patients Pharmacy Calendar Resources

Monitoring Psychotropic Medications

[print pdf 21kb]

Contributors: Bennett, Brenner, Gonzalez, Graham, Marks, Strachan, Yuodelis-Flores

Objective – to provide clear & concise guidelines for the Primary Care Provider about what to monitor medically for patients taking psychotropic medications

General:

1) Weight gain may happen with many psychotropic medications. Please monitor for change in weight and BMI => do Fasting Blood Glucose and Lipid Panel if weight gain is noted.

2) Blood levels of psychotropic medications should be drawn as troughs (that is 12 hours since last dose). Additionally, patients should be monitored for clinical signs of toxicity with each visit rather than relying soley on blood levels. Blood levels can also confirm treatment adherence.

3) Marshalling Resources is critical in getting patients to engage in healthier behaviors; these include volunteer services, support groups, entertainment discounts or free tickets via Lifelong – please ask case manager and patient educator for more information.

Medication
Concern
Monitor
Freq
Anti-Manic Agents
Lithium Renal Failure
Hypothyroidism
Hypercalcemia
Lethal in OD

SCr
TSH
Ca

Q 3-6 mo.
Depakote
(Valproate)
Anemia
Thrombocytopenia
Hepatic impairment
Pancreatitis

CBC
Platelets
LFTs
amylase

Q 3-6 mo.
Antipsychotic Agents
1st Generation
Haloperidol
(Haldol)
Hyperprolactinemia
Lower seizure threshold
Increased risk of TD in HIV infected patients
Prolactin Symptomatic
2nd Generation

Clozapine
(Clozaril)

Neutropenia
Diabetes

CBC/+ diff FBG

Weekly
Q 3 mo.
Olanzapine
(Zyprexa)
Diabetes
Hyperlipidemia

FBG
Lipid panel
BMI/weight

Q 6 mo.
Q 6 mo.
Each visit
Quetiapine
(Seroquel)
Diabetes
Hyperlipidemia

FBG
Lipid panel
BMI/weight

Q 6 mo.
Q 6 mo.
Each visit
Risperidone
(Risperdal)
Diabetes
Hyperprolactinemia
FBG
Prolactin
BMI/weight
Q 6 mo.
Symptomatic
Each visit
Ziprasidone
(Geodon)
Prolonged QT interval ECG
BMI/weight
Baseline
Each visit
Aripiprazole
(Abilify)

3A4 inhibitors double blood levels

BMI/weight Each visit
Antidepressants
TCAs Lethal in OD    
SSRIs

Increase risk of bleed
2 fold with NSAIDS due to anti-platelet mediated effects

 

Cautions use
with anticoag or bleeding d/o.

Duloxetine
(Cymbalta)
Contraindicated in Liver Failure (ascites, portal HTN, varices)
Can effect 2D6 metabolism
   

Venlafaxine
(Effexor)

HTN (dose dependent) Check BP Each visit
Mirtazipine
(Remeron)
Increase appetite Weight  
Bupropion
(Wellbutrin)
Lower seizure threshold
Contraindicated in eating d/o and seizure d/o
   
Nefazodone
(Serzone)
Idiopathic liver failure
Drug Intxn with 3A4
   
Sedatives
Alprazolam
(Xanax)
Drug Intxn with 3A4    
Triazolam
(Halcion)
Drug Intxn with 3A4    

 

*Adobe Acrobat Reader is required for viewing or printing PDFs. Acrobat Reader is available free of charge from the Adobe website at http://www.adobe.com/prodindex/acrobat/readstep.html