Important Monitoring Guideline for Psychotropic Medications 6/29/2017

Important Monitoring Guidelines for Psychotropic Medications

There are some important monitoring guidelines to keep in mind when prescribing psychotropic medications, to ensure that the medications are well tolerated and that patients are not developing problematic side effects. Here is a brief review of those guidelines:

All atypical and typical antipsychotics, especially olanzapine and clozapine Weight, BMI, Fasting glucose, lipid profile, blood pressure, waist circumference Baseline, monthly for first 3 months, then quarterly; after dose changes
Particularly high potency typical antipsychotics AIMS (Abnormal Involuntary Movement Scale) to assess for EPS Yearly
Clozapine CBC Weekly for 6 months then biweekly
Mood Stabilizers    
Lithium Thyroid function, renal function, CBC, weight, serum level, EKG in older patients Baseline, quarterly; after dose changes; monitor serum levels more frequently at first
Valproic Acid Liver function, CBC, weight, serum level Baseline, after one month, then quarterly; after dose changes; monitor serum levels more frequently at first
Carbamazepine Liver function, CBC, electrolytes, EKG in older patients, serum levels Baseline, at 1 month then quarterly; check CBC if signs of bleeding abnormality; check serum levels more frequently at first
Oxcarbamazepine Sodium Do not need to monitor sodium level but check if clinical symptoms are present
Gabapentin Kidney function Baseline, yearly
Lamotrigine Kidney and liver function Baseline
Topiramate Kidney and liver function Baseline
SSRIs n/a n/a
SNRIs Blood pressure Quarterly
Wellbutrin n/a n/a
Remeron Weight, blood pressure Baseline, then quarterly
Trazodone Monitor blood pressure at higher doses Quarterly
Tricylic Antidepressants EKG Consider at baseline

Alpha agonists

Clonidine, guanfacine Blood pressure Quarterly and with dose changes
Stimulants EKG Consider at baseline
Methylphenidate, dextroamphetamine Weight, blood pressure At one month, then quarterly
Benzodiazepines LFTs if long acting Baseline, yearly


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