Antipsychotics carry a known cardiometabolic burden, and the monitoring that catches it early is the step most often allowed to lapse once a patient is stable. A simple recurring schedule prevents weight gain, dysglycaemia and dyslipidaemia from going unnoticed for years.
Take weight or body mass index, waist circumference, blood pressure, fasting glucose or HbA1c and a lipid profile at baseline, again at around 12 weeks, and then at least yearly. Check prolactin where a patient on a prolactin-raising drug such as risperidone has relevant symptoms.
Act on what you find — lifestyle support first, a switch or a metabolic treatment where indicated — rather than only recording it. The monitoring is only useful if it changes something.
- Record weight or body mass index, waist, blood pressure, fasting glucose or HbA1c and lipids at baseline, about 12 weeks, then at least yearly.
- Check prolactin where a patient on a prolactin-raising drug such as risperidone has symptoms.
- Respond to abnormal results with lifestyle support, a switch, or metabolic treatment.
- Flag the monitoring schedule so it is not dropped once the patient is stable.
Why it matters
The cardiometabolic harm of antipsychotics is preventable, but only if the monitoring that detects it does not lapse once a patient is stable.
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