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Bipolar disorder - Management
How should I monitor someone taking antipsychotics?

  • Before starting risperidone, olanzapine, or quetiapine:
    • Record the person's height and body weight, and measure plasma glucose and lipids.
    • If the person has cardiovascular disease or risk factors for cardiovascular disease, do an electrocardiogram.
    • If risperidone is to be prescribed, measure prolactin levels.
  • After starting risperidone, olanzapine, or quetiapine:
    • Measure plasma glucose and lipids (preferably fasting levels) at 3 months (or within 1 month if taking olanzapine).
    • Measure body weight at 3 months, or more often if the person is gaining weight rapidly.
  • For people maintained on risperidone, olanzapine, or quetiapine:
    • If levels of plasma glucose or lipids are elevated, monitor regularly (every 3 months), or more often if there is evidence of elevated levels.
    • Monitor body weight every 3 months, or more often if the person is gaining weight rapidly.
    • If the person is taking risperidone, measure prolactin level if symptoms of raised prolactin develop (these include low libido, sexual dysfunction, menstrual abnormalities, gynaecomastia, and galactorrhea).
Basis for recommendation
  • Hyperglycaemia and sometimes diabetes can occur in people taking atypical antipsychotics. Monitoring weight and plasma glucose may identify the development of hyperglycaemia [BNF 56, 2008].
  • Risperidone, olanzapine, and quetiapine can all increase lipid levels [Taylor et al, 2007].
  • Risperidone can cause elevated prolactin levels [ABPI Medicines Compendium, 2008d].

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