Table 2: Assessment, monitoring, and patient education regarding orthostatic hypotension, hypertension, arrhythmias/torsades de pointes, and myocarditis in antipsychotic-treated patients.

Side effect
process/step
Orthostatic hypotensionHypertensionArrhythmias/torsades de pointesMyocarditis

Assessment(1) Elderly (>65 years of age)
(2) Risk of osteoporosis or have osteoporosis
(3) Disorders that predispose to orthostasis or fall risk (e.g., dementia, gait disorder, and parkinsonism)
(4) Assess baseline blood pressure and heart rate in supine and standing positions prior to starting drug therapy
(5) History of injury (i.e., hip fractures) or falls
(6) Taking any types of over-the-counter medications that may cause dizziness (e.g., allergy remedies, antihistamines, cold remedies, or sleep aids)
(1) Assess baseline blood pressure, heart rate, and respiratory rate prior to starting drug therapy
(2) History of hypertension, heart disease, diabetes, and dyslipidemia
(3) History of smoking
(4) Family history of hypertension and heart disease
(5) Taking any type of illicit or over-the-counter medications with vasoconstrictive properties (e.g., decongestant, weight loss supplement, diet pills, or street drugs)
(1) Female gender
(2) History of heart disease
(3) Using a QT prolonging agent
(4) Have hypokalemia (K+ < 3.5 mEq/L)
(5) Using high dose of offending drug
(6) History of QT prolongation
(7) Family history of QT prolongation
(8) QTc > 450 msec as a baseline prior to drug therapy
(9) Have bradycardia
(10) Check baseline ECG prior to drug therapy
(11) Check blood pressure and heart rate baseline prior to drug therapy
(12) Check electrolytes baseline prior to drug therapy
(1) History of recent viral, bacterial, or parasitic infections
(2) Allergy to clozapine or any type of medications
(3) History of heart failure, cardiomyopathy, pericarditis, or heart attack

Monitoring(1) Check blood pressure periodically
(2) Check heart rate periodically
(1) Check blood pressure periodically
(2) Check heart rate periodically
(1) Check ECG periodically for abnormalities (i.e., QT prolongation)
(2) Check electrolytes periodically (i.e., sodium, potassium, and calcium)
(3) Check blood pressure and heart rate periodically
(1) Check ECG and chest X-ray periodically as needed
(2) Do blood draws periodically (i.e., WBC, RBC)
(3) Monitor levels of clozapine periodically
(4) Test for blood cultures for detecting any infection
(5) Check for heart rate, heart beat, and sounds
(6) Check for edema in the arms, legs, and lungs

Patient education(1) Take calcium and vitamin D supplement for bone health and strength
(2) Arise slowly from bed or chair when getting up
(3) Ask for assistance when having difficulty standing up
(4) Medication can cause dizziness and palpitations
(5) Avoid or limit the amount of alcohol beverage intake
(6) Consult your doctor or pharmacist prior to purchasing any over-the-counter medications
(1) Avoid excessive sodium salt intake
(2) Exercise regularly (at least 30 minutes/day for 5 days)
(3) Try to quit smoking or smoke less
(4) Avoid or limit the amount of alcohol beverage intake
(5) Consult your doctor or pharmacist prior to purchasing over-the-counter medications
(1) Let your doctor know if your heart rate is very fast or very slow
(2) Check your heart rate and blood pressure regularly
(3) Ask your doctor prior to purchasing over-the-counter medications
(4) Maintain a well-balanced diet
(5) Try to quit smoking or smoke less
(1) Let your doctor know if you have fever, chest pain, joint pain or swelling, abnormal heart beats, fatigue, shortness of breath, fainting, low urine output, leg swelling, and the inability to lie flat
(2) Check your heart rate regularly