Psychiatric Pharmacy Essentials: Psychotropic Medication Monitoring: Antipsychotics

Antipsychotics are associated with adverse effects. Clinicians should adhere to conscious monitoring of the adverse effects related to use with antipsychotics. Experts have formulated recommendations regarding monitoring parameters to assist with prevention, early detection, and management of potential adverse effects.

  • What are some general rules to follow when prescribing antipsychotics? 1-3
  • Which vitals, labs, and screenings should be ordered for patients receiving antipsychotics and how frequently? 3-6
  • How can pharmacists assist with metabolic monitoring for patients receiving antipsychotics? 6-8
  • How does a clinician manage comorbid metabolic syndrome disorders in patients with mental illness? 9-15
  • What is the role of appetite suppression and GLP-1s for patients chronically using antipsychotics? 16-18
  • What are some strategies to effectively monitor for extrapyramidal symptoms (EPS)? 3,11,19

Reviewer 1: Meagan Dean, PharmD
Reviewer 2: Austin Smith, PharmD, BCPP
2024-2025 AAPP Resident and New Practitioner Committee

References

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  2. Adams KS. Toolbox: Metabolic adverse effects of atypical antipsychotics. Ment Health Clin. 2013;3(3):115-8. [Weblink]
  3. San Francisco Health Network Behavioral Health Services Medication Use Improvement Committee. Safer prescribing of antipsychotic medications guideline. 2021. [Weblink]
  4. American Diabetes Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. J Clin Psychiatry. 2004;65(2):267-72. [PubMed]
  5. Hasnain M, Vieweg WVR, Frederickson SK, et al. Clinical monitoring and management of the metabolic syndrome in patients receiving atypical antipsychotic medications. Prim Care Diabetes. 2009;3(1):5-15. [PubMed]
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  7. Azfr Ali RS, Jalal Z, Paudyal V. Guidelines versus practice in screening and monitoring of cardiometabolic risks in patients taking antipsychotic medications: where do we stand? Gen Psychiatr. 2021;34(4):e100561. [PubMed]
  8. Hibner TA, Wakefield AN, Eaves SM, et al. Metabolic monitoring of second-generation antipsychotics: evaluation of a pharmacist- and nurse-driven protocol. J Am Pharm Assoc. 2020;60(5S):S88-92. [PubMed]
  9. DeJongh BM. Clinical pearls for the monitoring and treatment of antipsychotic induced metabolic syndrome. Ment Health Clin. 2021;11(6):311-319. [PubMed]
  10. Griebe K, Caniff K, Bostwick J. Psychiatric pharmacists: key allies to improve antipsychotic metabolic monitoring. Psychiatr Serv. 2016;67(4):469-470. [PubMed]
  11. American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia. Table 2. 2020. [Weblink]
  12. Bermudes RA, Keck PE, McElroy SL. Managing metabolic abnormalities in the psychiatrically ill: A clinical guide for psychiatrists. American Psychiatric Publishing. 2007. [Weblink] (Only book available)
  13. Dayabandara M, Hanwella R, Ratnatunga S, et al. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat. 2017;13:2231-41. [PubMed]
  14. Saldaña SN, Kawsky J. Monitoring and treatment of weight gain in children and adolescents treated with second generation antipsychotics (SGAs). Men Health Clin. 2011;1(1):3-5. [Weblink]
  15. Cooper SJ, Reynolds GP, Barnes T, et al. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. J Psychopharmacol. 2016;30(8):717-48. [PubMed]
  16. Mukhejee S, Skrede S, Milbank E, et al. Understanding the effects of antipsychotics on appetite control. Front Nutr. 2022;8:815456. [PubMed]
  17. Arillotta D, Floresta G, Guiruis A, et al. GLP-1 receptor agonists and related mental health issues; insights from a range of social media platforms using a mixed-methods approach. Brain Sci. 2023;13(11):1503. [PubMed]
  18. Siskind D, Hahn M, Correll CU, et al. Glucagon-like peptide-1 receptor agonists for antipsychotic-associated cardio-metabolic risk factors: a systematic review and individual participant data meta-analysis. Diabetes Obes Metab. 2019;21(2):293-302. [PubMed]
  19. AAPP. The AIMS assessment and tardive dyskinesia. [Weblink]