Table 8.

. Long-Term Monitoring Parameters for Patients With Bipolar Disorder^a

Patient Is Maintained On:	Check	Monitor For:
Lithium	Serum level: once therapeutic level is achieved, every 3–6 mo	Subtherapeutic or toxic level
	EUC: every 3–6 mo	Renal insufficiency, nephrogenic diabetes insipidus
	Calcium, TSH, weight: after 6 mo and then annually	Thyroid/parathyroid dysfunction
Divalproex	Serum level: during initial therapy and then as clinically indicated	Subtherapeutic or toxic level
	Weight, complete blood count, menstrual history, liver function tests every 3 mo for the first year and then annually	Weight gain, thrombocytopenia, dysmenorrhea, liver failure
	Blood pressure, fasting blood glucose, lipid profile, bone densitometry (if risk factors)	Metabolic syndrome, anticonvulsant-related osteopenia
Carbamazepine	Serum level: during initial therapy and then as clinically indicated	Subtherapeutic or toxic level
	Complete blood count, liver function tests, EUC monthly for 3 mo then annually	Blood dyscrasias, liver failure, hyponatremia
	Bone densitometry and evaluation of oral contraceptive efficacy when applicable	Anticonvulsant-related osteopenia, increased metabolism of oral contraceptives
	Monitor for rash	Stevens-Johnson Syndrome
Lamotrigine	Monitor for rash	Stevens-Johnson Syndrome
Second-generation antipsychotics	Weight monthly for 3 mo and then every 3 mo	Weight gain
	Blood pressure, fasting blood glucose, lipid profile every 3 mo and then annually	Metabolic syndrome
	Monitor for abnormal movements	Acute dystonias, drug-induced parkinsonism, tardive dyskinesia
	Electrocardiogram, prolactin as clinically indicated	QTc prolongation/dysrhythmias, hyperprolactinemia

^aBased on Ng et al.⁵²

Abbreviations: EUC = electrolytes, urea, creatinine; TSH = thyroid-stimulating hormone.