Essential Tools for Atypical Antipsychotics Monitoring

To assist you in monitoring your patients who are prescribed atypical, or second-generation, antipsychotics (SGAs), Magellan has developed a tip sheet and monitoring log pertaining to SGAs, which briefly describes the benefits, issues, and side effects of these medications. Magellan also created an informational sheet for member use, Medication Safety and Second-Generation Antipsychotics, which you may find helpful when treating patients taking atypical antipsychotics.

Examples of currently available medications in the class of SGA include:

  • Risperidone (Risperdal®)
  • Olanzapine (Zyprexa®)
  • Quetiapine (Seroquel®)
  • Ziprasidone (Geodon®)
  • Aripiprazole (Abilify®)
  • Clozapine (Clozaril®)
  • Risperidone (Risperdal® Consta®)
  • Paliperidone (Invega® / Sustenna®)
  • Asenapine (Saphris®)
  • Iloperidone (Fanapt®)
  • Symbyax® (Zyprexa and Prozac combined)
  • Zyprexa® Zydis®

These are collectively grouped as SGAs because they share some advantages over the original, first-generation antipsychotics (FGA), such as chlorpromazine hydrochloride (Thorazine®) and haloperidol (Haldol®). These newer SGA agents have a lower tendency to cause extrapyramidal side effects — such as rigidity, tremor, and akathisia — than do the FGAs, but they do have their own set of side effects that must be monitored. These side effects can include weight gain, type 2 diabetes, hyperlipidemia, and prolactin elevation.

The Second Generation Antipsychotic Monitoring Results document includes questions on whether the following factors were assessed at baseline and/or follow-up visits, as recommended by a consensus guideline promulgated by the American Diabetes Association, American Psychiatric Association, and the American Association of Clinical Endocrinologists:

  • personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease;
  • weight and height (or BMI);
  • blood pressure;
  • fasting plasma glucose;
  • fasting lipid profile.

When treating a patient taking SGAs, it is equally important to coordinate with other providers involved in his or her treatment to promote consistency in the individual’s care and lead to more efficient and longer-lasting stabilization. Asking your patients to complete a consent to share information form to facilitate timely exchange of pertinent knowledge and referrals to other levels of care if necessary can assist in such coordination.

Note: These guidelines are not intended to replace a practitioner’s clinical judgment. They are designed to provide information and to assist practitioners with decisions regarding care. The guidelines are not intended to define a standard of care or exclusive course of treatment. Health care practitioners using these guidelines are responsible for considering their patients’ particular situation in evaluating the appropriateness of these guidelines. This information is not a statement of benefits. Benefits may vary and individual coverage will need to be verified by the Plan.

Magellan Behavioral Health, Inc. is an independent company contracted by Independence Blue Cross and its affiliates (“IBC”) to manage and provide a provider network for behavioral health (mental health/substance abuse) benefits for the majority of benefit plans offered and administered by IBC.