What metabolic monitoring is appropriate when patients are taking antipsychotic medication? Are there any labs or vital signs to monitor?

Patients taking antipsychotic medications are a population at increased risk for metabolic problems such as diabetes, hyperlipidemia, hypertension, or obesity. Monitoring depends on the individual patient’s history, preexisting conditions, use of other medications, risk factors and health status. The APA schizophrenia guideline includes recommendations regarding metabolic monitoring.

Recommended assessments at baseline include: pulse, blood pressure, weight, height, calculation of body mass index, fasting blood glucose or hemoglobin A1C, lipid panel, CBC, electrolytes, renal function tests, hepatic function tests, TSH. Pregnancy testing is recommended for women of childbearing potential. Toxicology testing and prolactin levels are recommended if clinically indicated.

Follow-up assessments include pulse and blood pressure at each visit or as clinically indicated. Follow-up assessments at each visit for 6 months and then quarterly include: weight, height, and calculation of body mass index.

Follow-up assessments at 4 months after initiating a new treatment and annually thereafter include: fasting blood glucose or hemoglobin A1C, and lipid panel.



American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia.

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