Table 6 Recommendation for testing, timing intervals, physician and institutional level actions for optimal safety monitoring in resource limited settings
Drug | Physician level actions | Institutional level actions |
|---|---|---|
Lithium | 1.Request Serum lithium, electrolytes, and creatinine at least every 6 months 2. Educate patients on the importance of safety monitoring with blood test to overcome patient based barriers 3. Conduct clinical audits for safety monitoring 4. Request serum calcium and TSH annually 5. Record all tests done in patient held records | 1.Have one form for requesting serum lithium with tick boxes for electrolytes, and creatinine 2. Ensure availability of serum lithium testing facilities at all times 3. Promote conducting clinical audits for safety monitoring and implement audit based quality improvement programmes through Healthcare quality and safety units of hospitals. 4. Make arrangements to give dates for blood testing from the clinics eliminating the need to come another day to get a test date |
5. Ensure availability of serum Calcium and TSH testing facilities at all times | ||
Sodium valproate | 1. Request full blood count, liver enzymes (AST/ALT) at baseline and annually | 1. Training and continuous professional development activities for medical staff on the need for safety monitoring for alternative mood stabilizers. |
2. Request therapeutic drug monitoring (TDM) of sodium valproate, fasting glucose and lipid profiles at initiation of therapy and when clinically indicated 3. Record all tests done in patient held records | 2. Establish TDM facilities for sodium valproate in government sector and inform availability to clinics | |
Carbamazepine | 1. Request full blood count, liver enzymes (AST/ALT), electrolytes, and creatinine annually | 1. Training and Continuous Professional Development (CPD) activities for medical staff on the need for safety monitoring for alternative mood stabilizers |
2. TDM of carbamazepine at initiation of therapy and when clinically indicated 3. Record all tests done in patient held records | 2. Establish TDM facilities for carbamazepine in government sector and inform availability to clinics | |
Atypical antipsychotics e.g.: Olanzapine, Risperidone, Quetiapine | 1. Request fasting blood glucose and fasting lipid profile annually 2. Record all tests done in patient held records | 1. Training and CPD activities for medical staff on the need for safety monitoring for newer antipsychotics 2. Establish facilities for lipid profile testing in the government sector |