What metabolic monitoring is recommended after initiating a second-generation antipsychotic?

• A. Baseline and periodic weight/BMI, fasting glucose/HbA1c, and lipid panel.
• B. Baseline and periodic liver enzymes.
• C. No monitoring necessary.
• D. Sleep study.

Answer: (A)

Second-generation antipsychotics can cause metabolic side effects such as weight gain, insulin resistance, high blood sugar, and abnormal fats in the blood. Because these changes can develop over time, it’s important to establish a baseline and then monitor regularly. The best monitoring includes baseline and periodic measurements of weight and BMI to track weight gain, fasting glucose or HbA1c to detect impaired glucose regulation, and a lipid panel to catch dyslipidemia. This combination gives a clear picture of metabolic health over time and helps guide decisions about lifestyle interventions or adjusting treatment if risks emerge. Liver enzyme tests or sleep studies don’t specifically track these metabolic risks, and skipping monitoring would miss early signs of metabolic syndrome.