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:
| MEDICATION | LAB/MEASUREMENT | FREQUENCY |
| Antipsychotics | ||
| 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 |
| Antidepressants | ||
| 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 |
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| 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 |