In light of the increased use of antipsychotics in children and adolescents, how often should a lipid panel be checked? Is it common practice to obtain baseline labs prior to starting an antipsychotic? If so, which labs?—KIM OBERSTAR, PNP, South St. Paul, Minn.
While they may not have been routinely done in the past, baseline lipid levels and hepatic enzyme function tests certainly seem prudent now. Research demonstrates elevations in triglycerides, cholesterol, glucose, alanine aminotransferase, and aspartate aminotransferase in patients taking antipsychotics (Eur Arch Psychiatry Clin Neurosci. 2002;252:294-298 and 2002;11:129-133). Weight gain is also a side effect of the atypical antipsychotics. Baseline weight, BMI, and BP should be obtained and evaluated at each visit. Recommendations vary depending on the schedule for monitoring lipids, glucose, and liver function tests, but follow-up at three, six, and 12 months in the first year of treatment seems appropriate. If no significant changes have occurred in the first year, frequency of monitoring can decrease to every 6-12 months. — Julee B. Waldrop, MS, PNP (143-5)