Medication monitoring guidelines

All antipsychotics

• AIMS or DISCUS annually (atypical) or bi-annually (typical)
• Height and weight annually
• Labs at start, 4 months after start, then annually:
  • Fasting (preferred) lipid and HgA1c
  • Fasting lipid profiles; if LDL level > 130 mg/dl refer for treatment, repeat within 6 months

• AIMS or DISCUS annually
• Height and weight annually
• Labs at start, 4 months after start, then annually:
• Fasting plasma glucose level or HgA1c
• Fasting lipid profiles; if LDL level > 130 mg/dl refer for treatment, repeat within 6 months
• WBC and ANC (PMNs in “WBC with differential”) at baseline and every week for 6 months. Then if WBC is at least 3500/mm3 and ANC is at least 2000/mm3 for 6 months, decrease to every two weeks. If maintains WBC > 3500/mm3 and ANC > 2000/mm3 for 6 months, decrease WBC and ANC to every 4 weeks.
• If WBC <3,000/mm3 or ANC<1,500/mm3: re-increase frequency of monitoring.
• When discontinuing Clozaril, weekly WBC and ANC at least 4 weeks and until WBC = 3500/mm3 and ANC = 2000/mm3

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq)
• Levomilnacipran ER (Fetzima)

• Blood pressure with start of medication, dose change and annual
• Levomilnacipran ER (Fetzima) Annual Creatinine level.
• Duloxetine LFT’s if liver disease suspected

• Weight reported/documented at each visit for one year then annually
• TCA EKG if cardiac disease

• Check and document PDMP at visit when medication started and at minimum twice/annually (or frequency as determined by state requirements)
• Follow up within 30 days of start, then quarterly
• Blood pressure at start, with dose change and annually
• Weight reported/documented at every visit under age 16
• Height documented at every 6 month under age 16

• Weight reported/documented every visit under age 16
• Consider LFT

• Weight reported/documented at each visit for one year then annually
• Labs at one month after start, 6 months after start then annual:
  • HEMOGRAM/PLTS
  • AST
  • Valproate level

• Weigh at each visit for one year then annually (if not already performed in another clinic within past 2 months).
• Baseline labs:
  • HEMOGRAM/PLTS/DIFF
  • LFTs
  • Kidney function tests
  • *Consider screening for HLA-B*1502 allele for individuals with ancestry from Asia (Those with this allele should not be treated with this medication)
• Labs at 2 weeks after start or dose change, 6 months after start then annual:
  • HEMOGRAM/PLTS/DIFF
  • LFTs
  • Kidney function tests
  • Consider monitor Na if sx due to risk of hyponatremia
  • Not required, consider if change in clinical sx, pregnancy, suspect toxicity, minor-Tegretol level

• Weigh at each visit for one year then annually
• Labs before initiating treatment: BMP ( BUN/Creatinine), pregnancy test, TSH,
• Initial monitoring:Trough (about 12 hours after last dose)
• Lithium level at 1 week until desired serum concentration achieved
• Labs every 6-12 Months for stable monitoring:
  • Lithium level
  • Basic Metabolic Panel
• Annual Labs:
  • TSH

• Labs at 3 months and 6 months after start then annually
  • Basic Metabolic Panel (look for hypercalcemia)
  • UA with micro

• LFT’s at baseline and then annually.

• Baseline LFT’s and Renal Function
• Monthly LFT’s for first 6 months