PART 3 / CH 60
Laboratory Monitoring of Psychiatric Medications
Roy Perlis (adapted from Jonathan Alpert)
A. Mood stabilizers
| drug | pre-rx | titration | during rx |
|---|---|---|---|
| Lithium | lytes/BUN/Cr CBC, U/A TSH EKG* beta-HCG ?24h urine | weekly level, Cr (draw level 12h post last dose; steady state takes 4-5d) | Level, Cr, TSH q6months or with new dose (q1-3months initially) EKG* q6-12m U/A q1year |
| valproate | CBC w/ diff LFT beta-HCG | weekly level, CBC, LFT | Monthly level, LFT, CBC x6, then q6months |
| carbamazepine | CBC w/ diff, LFT,TSH beta-HCG EKG* | weekly level, CBC, LFT | Monthly level, LFT, CBC x6, then q6months ?TSH, lytes |
? = practice varies; *= EKG in children, patients >50 or with known cardiac disease or risk factors.
B. Antidepressants
· generally require no routine baseline or monitoring labs; check LFT’s if history of abnormality.
· exception: tricyclic antidepressants
- baseline EKG*
- levels may be useful in some settings
C. Antipsychotics
· all: signed consent form; AIMS test at baseline, every 6 months
· risperidone, low-potency agents: EKG*
· clozapine: weekly WBC with differential (see Clozapine section)