Before and During Treatment

Before you start an antipsychotic, your doctor will usually run some checks to make sure the medicine is safe for you. Once you’re on it, you’ll also have regular reviews to track how well it’s working and watch for side effects.

Pre-treatment Health Assessments

Pre-treatment health assessments are the checks a doctor or care team does before starting you on medication such as an antipsychotic. They help make sure the treatment is safe and right for you, and set a baseline for your health so any changes can be spotted later.

For antipsychotics this usually means:

• Checking your weight and waist size
• Measuring blood pressure and heart rate
• Asking about lifestyle habits like diet, exercise and sleep
• Looking for any signs of movement problems
• Discussing smoking, vaping or alcohol use
• Reviewing other medicines or substances you’re taking
• Blood tests for sugar, cholesterol, red blood cells (haemoglobin) and prolactin
• Sometimes a heart check (ECG) if your doctor thinks it’s needed

Ongoing Monitoring

After you start antipsychotics, your care team will keep an eye on:

• Whether you’re taking your medicine regularly
• How well it’s working
• Any side effects

If you’re on higher doses, you may have ECG tests every 1 to 3 months to check for heart side effects.

Special Considerations

Tell your doctor about any other health conditions you have, as they can affect which medicine is safest for you. This includes:

• Liver or kidney problems
• Heart issues
• Diabetes
• Conditions like Parkinson’s or epilepsy
• Breathing problems or blood disorders

Age-Related Factors

For older people, doses often need to be lower because of:

• Blood pressure changes
• Body temperature regulation issues
• Slower processing of medicine with age

Drug Interactions

Always let your doctor know about other medicines you take, even over-the-counter ones, as they can interact.

Extra care is needed with:

• Drugs with antimuscarinic effects
• Some sleeping tablets and anti-anxiety medicines
• Mood stabilisers like carbamazepine and lithium
• Antidepressants
• Alcohol and recreational drugs

Ask for regular reviews and always feel able to discuss your medication plan with your doctor or care team.

The Dosage

Finding the right dose is personal. It depends on:

• The antipsychotic you take: Each one has its own safe range.
• Other medications: Some drugs affect how your antipsychotic works.
• You: Age, weight, health and genetics all play a part.

Your doctor or psychiatrist will work with you to find a dose that helps you without causing too many side effects.

They should explain what the medicine is expected to do and when you might notice changes.

Fine-Tuning Your Dose

• Start low: Lower doses are often just as effective.
• Trial the dose: Stay on the starting dose for 4–6 weeks to see how it works.

Your doctor may adjust the dose with you if needed. If the medication doesn’t work even at the highest safe dose, or if side effects are too strong, another antipsychotic might be tried.

All changes should be written in your medical notes, especially if the dose is higher than usual.

Risks of Higher Doses

Higher doses increase the chance of side effects. Some antipsychotics can affect:

• Your daily routine
• Muscle movements
• Everyday activities

Higher doses can also raise the risk of tardive dyskinesia, which causes uncontrollable movements.

PRN Prescribing

‘PRN’ means ‘as needed’. In hospital, you might be given extra doses on top of your regular dose. These must be written in your records and your doctor should keep track of the total amount you’ve had that day.

Is My Dose Too High?

You can check the British National Formulary (BNF) for UK maximum doses. If you’re worried about how much you’re taking, ask your doctor to review your medication, even if you’re within the usual range.