Posted by ed_uk2010 on January 20, 2015, at 8:55:49
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 20, 2015, at 6:19:54
High dose antipsychotic treatment can include above maximum doses of single drugs, combinations which count as high doses when taken together, or in your case - both. In terms of physical monitoring, intermittent ECGs, pulse and blood pressure monitoring, and weight/BMI checks should be sufficient for you. Temperature monitoring is more important for the elderly, and in those treated with high-potency neuroleptics like haloperidol (due to the higher risk of neuroleptic malignant syndrome with these drugs).
Blood tests performed to monitor antipsychotic safety may include:
Plasma glucose, and possibly HbA1c - diabetes checks. Early morning glucose level after an overnight fast is useful.
Plasma lipids - cholesterol, triglycerides. Triglycerides in particular are often elevated by olanzapine. Quetiapine sometimes does the same. Amisulpride causes much milder metabolic changes.
Plasma electrolytes and kidney function - electrolytes such as potassium must be normal for high doses of antipsychotics to be used. Kidney function should be checked in metformin and amisulpride users. Amisulpride and metformin are eliminated predominantly by the kidneys. Olanzapine and quetiapine are excreted following metabolism by the liver.
Full blood count and liver function tests - may be performed occasionally. Quetiapine sometimes leads to abnormal results here but they are usually minor. Full blood counts are useful for general health monitoring, however.
Prolactin - can be measured if sexual dysfunction or loss of libido occurs, or once or a maintenance dose of amisulpride has been established, or after 3 months of treatment (in the absence of symptoms). It's useful to have a baseline before starting antipsychotics (or a new antipsychotic), but in your case it was probably normal or mildly elevated before starting amisulpride. Quetiapine rarely causes significant prolactin elevation. Olanzapine sometimes causes mild elevations, but marked elevations are uncommon. I think you should assume minor/insignificant elevation before starting amisulpride, and take that as your baseline. Prolactin is best measured around an hour after waking, and an hour after breakfast. Stress should be minimised because it can cause a spike in prolactin levels. It is often necessary to re-test if a moderate elevation is found. If it is normal, or if it is extremely high - that tells you more.
I imagine you'll be able to get most physical monitoring and blood tests through your non-psych doctor. Apart from prolactin, all the tests are very routine indeed.
poster:ed_uk2010
thread:1074889
URL: http://www.dr-bob.org/babble/20150102/msgs/1075284.html