Antipsychotic

Question 1

Monitoring

Answer 1

Full blood count, urea and electrolytes, liver function test, fasting blood glucose, blood lipids,
blood pressure, weight, ECG.

Question 2

Warning signs

Answer 2

• Hyperthermia
• Muscle rigidity
• Fluctuating levels of consciousness
• Tachycardia
• Labile blood pressure

Question 3

Actions required

Answer 3

• ECG should be repeated periodically and dose reduced if QT interval is prolonged or other
adverse cardiac abnormality develops
• Patients should maintain adequate fluid intake
• Doses should be increased slowly and not more often than once weekly
• Initial doses in elderly patients should be reduced to at least half the adult dose and treatment
should be reviewed regularly
• Prescribing more than one antipsychotic drug at a time should be avoided except in
exceptional circumstances
• There is a high risk of relapse if antipsychotic medication is stopped after 1-2 years. Patients
should be monitored for 2 years after withdrawal of long-term antipsychotic medication for
signs and symptoms of relapse
• Photosensitisation may occur with higher dosages and patients should therefore avoid direct
sunlight
• Inform patients that drowsiness may occur especially at the start of treatment and the effects
of alcohol can be enhanced

Question 4

Interactions

Answer 4

• Increased hypotensive effect with ACE inhibitors, angiotensin II receptor antagonists, calcium
channel blockers and beta-blockers
• Increased sedation with antihistamines and anxiolytics. Increased sedation and hypotensive
effects with opioid analgesics
• Increased risk of QT-prolongation with amiodarone, sotalol, citalopram, escitalopram,
methadone and macrolide antibiotics
• Increased risk of extrapyramidal side effects with metoclopramide and amantadine