47 - References

References

Prolactin Children and adolescents only At start and if symptoms of raised prolactin develop   Raised prolactin unlikely with quetiapine or aripiprazole. Very occasionally seen with olanzapine and asenapine. Very common with risperidone and FGAs. ECG If indicated by cardiovascular disease or risk factors At start if there are risk factors for or existing cardiovascular disease (or haloperidol is prescribed). If relevant abnormalities are detected, re-­check after each dose increase. At start if risk factors for or existing cardiovascular disease. If relevant abnormalities are detected re-­check after each dose increase. At start if risk factors for or existing cardiovascular disease. If relevant abnormalities are detected, re-­check after each dose increase. Waist circumference and/or body mass index Yes Yes, as part of a routine physical health check Monthly for the first 3 months then annually At start, and then every 6 months Every 3 months for the first year then annually At start and when needed if the patient gains weight rapidly Plasma levels of drug At least 3–­4 days after initiation and 3–­4 days after every dose change until levels stable, then every 3 months in the first year, then every 6 months for most patients (see NICE2) Titrate by effect and tolerability. Do not routinely measure unless there is evidence of lack of effectiveness, poor adherence or toxicity. Two weeks after initiation and 2 weeks after dose change. Thereafter, do not routinely measure unless there is evidence of lack of effectiveness, poor adherence or toxicity. For patients on lamotrigine, do an annual health check, but no special monitoring tests are needed although blood levels may indicate if high doses might be considered. References

1. Ng F, et al. The International Society for Bipolar Disorders (ISBD) consensus guidelines for the safety monitoring of bipolar disorder treatments. Bipolar Disord 2009; 11:559–­595.
2. National Institute for Health and Care Excellence. Bipolar disorder: assessment and management. Clinical guideline [CG185]. 2014 (last updated December 2023, last accessed October 2024); https://www.nice.org. uk/guidance/cg185.