• Assess mental status (orientation, mood, behavior) and degree of anxiety prior to and periodically during therapy.
• Assess weight and BMI initially and throughout therapy.
• Assess positive (hallucinations, delusions, agitation) and negative (social withdrawal) symptoms of schizophrenia.
• Monitor BP (sitting, standing, lying), ECG, pulse, and respiratory rate prior to and frequently during the period of dosage adjustment. May cause Q-wave and T-wave changes in ECG.
• Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded or cheeked.
• Assess patient for level of sedation following administration.
• Monitor intake and output ratios and daily weight. Notify health care provider if significant discrepancies occur.
• 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 of hands, mask-like face, shuffling gait, rigidity, tremors; and dystonic: muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. 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. Benzodiazepines may alleviate akathisia.
• 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 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 professional immediately if these symptoms occur.
• Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual dysfunction).

Lab Test Considerations:

• CBC, liver function tests, and ocular examinations should be evaluated periodically during therapy. Obtain fasting blood glucose and cholesterol levels initially and throughout therapy. May cause ↓ hematocrit, hemoglobin, leukocytes, granulocytes, platelets. May cause ↑ bilirubin, AST, ALT, and alkaline phosphatase. Agranulocytosis occurs at 4–10 wk of therapy, with recovery 1–2 wk following discontinuation. May recur if medication is restarted. Liver function abnormalities may require discontinuation of therapy.
  • May cause false-positive or false-negative pregnancy test results and false-positive urine bilirubin test results.
  • Monitor serum prolactin prior to and periodically during therapy. May cause ↑ serum prolactin levels.