TABLE 13

Adverse Effects and Possible Monitoring of Atypical Antipsychotics

Adverse effectTime courseSuggested monitoringMedications most likely to cause
AnticholinergicEarlyClozapine, olanzapine
Acute parkinsonismEarlyDuring titration, at 3 mo and annuallyPaliperidone, risperidone
AkathisiaEarly/intermediateDuring titration, at 3 mo and annuallyAripiprazole
Cardiovascular eventsNot knownEKG at baseline if taking ziprasidone or clozapine and during titration if taking ziprasidone
DiabetesLateFasting blood glucose at 3 mo and then every 6 moClozapine, olanzapine (but problem for all)
Increased lipidsEarly?Lipids at 3 mo and then every 6 moClozapine, olanzapine (but problem for all)
NeutropeniaMost likely within first 6 moClozapine registry recommended CBC monitoringClozapine
OrthostasisEarlyOrthostatic blood pressure and pulse if symptomatic; blood pressure and pulse at 3 mo and annuallyClozapine, olanzapine, quetiapine
Increased prolactin and sexual dysfunctionEarlySexual history during titration and then every 3 mo; prolactin level only if symptomaticPaliperidone, risperidone, olanzapine
Decreased prolactinEarlyProlactin level only if symptomaticAripiprazole
Increased QTc intervalNot knownEKG at baseline if taking ziprasidone or clozapine and during titration if taking ziprasidoneZiprasidone
SedationEarlyEach visitClozapine, olanzapine, quetiapine (but problem for all)
SeizuresDuring titrationClozapine
Tardive dyskinesiaLateAt 3 mo and annually (abnormal involuntary movement scale)Lower risk compared with first generation antipsychotics
Withdrawal dyskinesiaEarly during fast switchDuring titrationAripiprazole, paliperidone
Wt gainFirst 3–6 moHeight, wt, BMI percentile, BMI z score each visitAll, but clozapine and olanzapine highest and aripiprazole and ziprasidone least
Other laboratoriesElectrolytes, CBC, renal function test annually, and liver function tests at 3 mo and annually