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Physical Health Monitoring of Antipsychotic Medications – Patient Information Leaflet

This leaflet explains how and why antipsychotic medications are monitored for possible side effects.

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  • Introduction

    Antipsychotic medications are used to help manage a number of different problems but they all have similar side effects. Our team will help you to manage any side-effects through regularly monitoring you whilst you are taking antipsychotic medications. This leaflet will explain:
    • Why we monitor antipsychotics
    • How we monitor antipsychotics
    • When you will need to have monitoring

  • Why we monitor

    Antipsychotic medications have a number of side-effects including:
    • Sleepiness
    • Weight gain
    • High blood pressure
    • High blood sugar levels
    • High blood fats (cholesterol/triglycerides)
    • Dizziness
    • Problems with movement such as shakes, stiffness, slowness
    • Sexual problems
    • Breast tenderness
    • Irregular periods/changes to your periods
    You might not always be aware of side-effects if they are slight and you may not associate them with your medication, so it’s important we look for and monitor any side-effects.

    Through monitoring we can:
    • pick up and act on side-effects which affect your life.
    • keep an eye on and act on changes increasing your risk of diabetes and heart disease
    • monitor changes that might make it unsafe to carry on taking antipsychotic medications.

  • How we monitor

    We have a Physical Health Clinic, staff at the clinic will monitor you whilst you are taking antipsychotic medication. They will check:

    Blood
    We do a range of blood tests which monitor your:
    • Liver
    • Kidneys
    • Cholesterol and fat levels
    • Full blood count
    • HbA1c – tells us about how well your body manages sugar levels
    • Prolactin – a hormone that can go up in the body which causes sexual side effects and changes to your periods.

    Weight
    We monitor your weight and measure your waist circumference, as weight gain is associated with health problems. We also calculate your BMI.

    Heart health
    If you have underlying health conditions, it may be recommended that you have an electrocardiogram (ECG).
    An ECG tells us about your heart rhythm. We get this by putting stickers over your chest and connecting these to the machine which then detects your heart rhythm.

    Side effect monitoring
    We will regularly ask you to complete a questionnaire about possible side effects that you may be experiencing.

    When we monitor
    Everyone prescribed antipsychotic medication is offered monitoring.
    If you are prescribed clozapine, you will need to have additional monitoring on a weekly, fortnightly or monthly basis. You will be informed of this.

    If you are prescribed a high dose of antipsychotics, you will require more frequent physical health monitoring. You will be advised about this.

    We’ll invite you for appointments at:
    • Weekly monitoring for the first six weeks. (The first appointment will be within two weeks of starting your medication) then;
    • Three months after starting medication and then
    • 12 months after starting medication
    After the first year you will only need to be monitored once a year for as long as you are prescribed antipsychotic medication.

    Not all checks are necessary at each appointment. These are the checks you can expect and when:

    • Blood tests
    Within two weeks of starting medication
    Three months (If you are prescribed Olanzapine three month checks take place again at six months and nine months.)
    12 months
    Yearly
    • ECG
    Within two weeks of starting medication
    Three months (If you are prescribed Olanzapine three month checks take place again at six months and nine months.)
    12 months
    Yearly (if recommended)

    • Body Mass Index (BMI)
    Within two weeks of starting medication
    Weekly for 5 weeks
    Three months (If you are prescribed Olanzapine three month checks take place again at six months and nine months.)
    12 months
    Yearly

    • Waist circumference
    Within two weeks of starting medication
    Weekly for 5 weeks
    Three months (If you are prescribed Olanzapine three month checks take place again at six months and nine months.)
    12 months
    Yearly

    • Side effects check
    Within two weeks of starting medication
    Weekly for 5 weeks
    Three months (If you are prescribed Olanzapine three month checks take place again at six months and nine months.)
    12 months
    Yearly

    • Lifestyle review
    Within two weeks of starting medication
    Three months (If you are prescribed Olanzapine three month checks take place again at six months and nine months.)
    12 months
    Yearly

    We recommend that you attend the monitoring clinics, but they are not compulsory. Sometimes there is value in remaining on the medications even where we do not have the full monitoring arrangements in place. As you are the decision maker in your care, we will be happy to discuss these arrangements with you and any aspect of the monitoring that you do not wish to take part in.

  • Further information

    If you have any queries about your medication please contact the Pharmacy Medicines Information helpline, Tel: 0191 245 6604. The helpline is available 9am – 4pm Monday to Friday (excluding public holidays). A voicemail facility operates at all other times.

  • What if I have a comment, suggestion, compliment or complaint about the service?

    If you want to make a comment, suggestion, compliment or complaint you can:
    • talk to the people directly involved in your care
    • ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk (click on the ‘Contact Us’ tab)
    • telephone the Complaints Department 0191 245 6672
    • email complaints@cntw.nhs.uk Please note that information sent to the Trust via email is sent at your own risk
    • We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.
    You can provide feedback in the following ways:
    - the quickest way for you to do this is to complete our short online survey at www.cntw.nhs.uk/poy
    - complete a Points of You survey, available from staff.

  • References

    • Prescribers Guide, Stephen M Stahl 5th Edition
    • Maudsley Prescribing Guidelines in Psychiatry, 13th Edition, David Taylor, Carol Paton, Shitij
    Kapur – Wiley Blackwell
    • Monitoring requirements for adult patients prescribed antipsychotics (except clozapine) (CNTW
    PPT-PGN-08)
    • Psychosis and schizophrenia in adults: prevention and management Clinical guideline (CG178)

  • Information about content, other formats and version control

    Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

    This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre
    Tel: 0191 246 7288

    Published by the Patient Information Centre
    2020 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

    Ref, PIC/787/1120 November 2020 V3
    www.cntw.nhs.uk Tel: 0191 246 7288
    Review date 2023