• Monitor mental status (orientation, mood, behavior) frequently.

  Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be ↑ in children, adolescents, and adults ≤24 yr. After starting therapy, children, adolescents, and young adults should be seen by health care provider at least weekly for 4 wk, every 3 wk for next 4 wk, and on advice of health care provider thereafter.

• Monitor BP and HR before and during initial therapy. Notify physician or other health care provider of ↓ in BP (10–20 mmHg) or sudden increase in HR. Patients taking high doses or with a history of cardiovascular disease should have ECG monitored before and periodically during therapy.
• Observe for onset of extrapyramidal side effects (akathisia: restlessness; dystonia: muscle spasms and twisting motions; pseudoparkinsonism: mask facies, rigidity, tremors, drooling, shuffling gait, dysphagia, pill-rolling motions of hands). Dose reduction or discontinuation may be necessary. Trihexyphenidyl or diphenhydramine may be used to control these symptoms.
• Monitor for tardive dyskinesia (lip smacking or puckering, puffing of cheeks, rhythmic chewing or worm-like movement of tongue and mouth, uncontrolled movements of extremities). Notify health care provider immediately if these symptoms occur; they may be irreversible.
• 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 provider immediately if these symptoms occur.
• Assess for sexual dysfunction.

Lab Test Considerations:

• May ↑ serum prolactin levels.
  • Monitor CBC and differential during chronic therapy. May rarely cause bone marrow suppression.
  • In chronic therapy, periodically monitor hepatic and renal function. Serum glucose may be ↑ or ↓.