Monitoring Psychotropic Medications

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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

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