What metabolic monitoring is appropriate when patients are taking clozapine? Should we monitor weight, labs or vital signs?

People taking antipsychotic medications are a population at increased risk for metabolic problems such as diabetes, hyperlipidemia, hypertension, or obesity. Antipsychotic medications vary in the likelihood that they will cause metabolic problems. Clozapine is among the medications that are more likely to cause these problems. Metabolic monitoring is important. The plan for monitoring depends on the patient’s history, preexisting conditions, use of other medications, risk factors and health status. The APA schizophrenia guideline includes general 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 with ANC, electrolytes, renal function tests, hepatic function tests, TSH. Waist circumference is one of the criteria for metabolic syndrome, but due to the high variability in measurements, most clinicians find that measuring weight is more satisfactory. Pregnancy testing is recommended for women of childbearing potential. Toxicology testing is recommended if clinically indicated.

Follow-up assessments include pulse and blood pressure as clinically indicated. At each visit for 6 months and quarterly thereafter, follow-up assessments include weight, height, and calculation of body mass index.

At 4 months, and annually thereafter, follow-up assessments include fasting blood glucose or hemoglobin A1C, and a lipid panel. ADA and APA guidelines recommend more frequent monitoring when indicated.



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

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