• Assess patient’s mental status (orientation, mood, behavior) prior to and periodically during therapy.
• Assess weight and BMI initially and throughout therapy.
• Observe patient carefully when administering medication to ensure medication is actually taken and not hoarded or cheeked.
• Assess fluid intake and bowel function. Increased bulk and fluids in the diet help minimize the constipating effects of this medication.
• Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian: difficulty speaking or swallowing, loss of balance control, pill rolling or hands, mask-like face, shuffling gait, rigidity, tremors; dystonic: muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs). Immediately report the onset of these symptoms. Parkinsonian effects are more common in geriatric patients, may occur during the first few days of therapy, and increase with dose increases. Akathisia and dystonias are more common in younger and male patients and may occur within 24–48 hr of initiation of therapy. Notify health care professional if these symptoms occur, because reduction in dosage or discontinuation of medication may be necessary. Trihexyphenidyl, diphenhydramine, or benztropine may be used to control these symptoms.
• Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue, excessive eye blinking). Notify health care professional immediately if these symptoms occur, because these side effects may be irreversible.
• Molindone may lower seizure threshold. Institute seizure precautions for patients with a history of a seizure disorder.
• Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur.
• Ocular examinations may be required periodically during high-dose or prolonged therapy to monitor for deposition of particulate matter on the lens or cornea.

Lab Test Considerations:

• Monitor WBC frequently during first few mo of therapy in patients with a history of a clinically significant low WBC or drug-induced leukopenia/neutropenia and periodically during therapy. Discontinue molindone in patients with severe neutropenia (absolute neutrophil count <1000/mm³); monitor WBC until recovery.
  • Liver function tests should be monitored periodically during therapy.
  • May cause alterations in BUN, RBCs, and serum glucose. These alterations are not clinically significant.
  • May cause ↑ serum prolactin concentrations during chronic use.