By Michael Robertson
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Extra resources for Acute Psychiatric Management
These may be benign abnormalities, but they also may be an indicator of myocarditis. The appearance of such anomalies warrants urgent cardiologist review. Patients with a history of cardiac illness or abnormal cardiac findings on physical examination should have a cardiology review prior to commencement of clozapine therapy. Cardiac monitoring during clozapine therapy should include: 1. Routine pulse and BP measurement 2. Pre-treatment ECG (serial measurements depending upon clinical indications) 3.
Fasting Glucose 5. Fasting Cholesterol and Triglycerides 6. ECG 7. Echocardiogram 8. Troponin and MB fraction Creatine Kinase 9. EEG (where indicated) Table 1. – Procedure for initiation of clozapine treatmen Baldessarini RJ, Frankenburg FR. A novel antipsychotic agent. New England Journal Medicine. 1991;324(11):746-54 and UK clozapine study group. The safety and efficacy of clozapine in severe treatment-resistant schizophrenic patients in the UK. British Journal Psych. 1993;150-54. 40. Kane J, Honigfield G, Singer J, et al.
Moreover, in many instances it is difficult to differentiate a putative teratogenic event related to psychotropic medication and a spontaneous abnormality in an otherwise unremarkable pregnancy, where such instances occur at a rate of 2-3% of all pregnancies carried to term. Classifications of medications in pregnancy The Australian Therapeutic Goods Administration (TGA) classification of drugs in pregnancy is shown in Table 1. Medications in Category C, D and X raise the most concerns, with the latter two warranting consideration of pregnancy in all female patients in their child bearing years.