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Question answered:07/04/08
CKS have a 2007 guideline on schizophrenia [1] which discusses monitoring patients on atypical antipsychotics. This includes the following:
“Monitoring adverse effects of drug treatment
Ask about adverse effects of drug treatment (GPP).
- Include extrapyramidal symptoms and tardive dyskinesia.
- Include common adverse effects, such as sexual dysfunction and lethargy.
- Include less common but serious adverse effects, such as palpitations.
- A rating scale, such as the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), may be useful.
Blood pressure and urine/blood glucose should be checked at least annually.
Consider routine weight monitoring, particularly if the person is receiving drugs that are known to cause weight gain (e.g. olanzapine).
Consider checking serum prolactin levels if there are symptoms suggestive of hyperprolactinaemia.
Check serum potassium levels at least annually, after dose increases, or if there are any symptoms that suggest emerging cardiac disease [CHM, 2006a]. Hypokalaemia increases the risk of arrhythmias.
Electrocardiographic (ECG) monitoring:
- Obtain a baseline ECG if the person is elderly, has a personal or family history of heart disease, or has cardiac abnormalities on examination [CHM, 2006a]. It is probably most practical to obtain a baseline ECG once psychotic symptoms have settled.
- Perform ECG during treatment if the person is experiencing palpitations or any other symptoms that suggest cardiac disease, or cardiac abnormalities are identified on examination [CHM, 2006a].
- Consider 6-monthly ECG monitoring if there is known ischaemic heart disease, structural heart disease, or QT prolongation, or if there are other factors that increase the risk of arrhythmias (e.g. co-prescription of other drugs that prolong the QT interval, such as tricyclic antidepressants or macrolides; use of more than one antipsychotic; use of a single antipsychotic in doses greater than BNF levels; hypokalaemia; hypocalcaemia; hypomagnesaemia) [Taylor et al, 2005].”
References
1) http://www.cks.library.nhs.uk/schizophrenia/view_whole_guidance
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