Medication monitoring

[kstarm]

We have been having some discussions about what type of labs are needed and how often for medications. I am curious what if any labs do you do and how often for certain medications. Obviously if the patient has underlying medical issues this will change.

Amitriptyline: We do not check anything
Duloxetine/Venlafaxine: Do not check anything
Gabapentin/Lyrica: Right now we are being asked to check yearly kidney function, I don't really see the need to do this unless underlying kidney issues.
Tizanidine: Yearly LFTs-I have caught a few patients with elevated LFTs after starting Tizanidine
Methocarbamol/Cyclobenzaprine/baclofen: Nothing
Topiramate: I know some people check CBC, we don't routinely.
Opioids: UDS of course, but we don't do testosterone routinely.
NSAIDS: I'll monitor kidney function after starting celebrex for those with minor risk factors.

How about you, what if any labs do you get and how often?

Tricyclics:
SNRIs:
Gaba/pregaba:
Tizanidine/metho/cyclobenzaprine/baclofen:
Topiramate:
Opioids:

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[oneforfighting]

I get an updated renal function on patients who I am planning on starting long term pain medications as most meds are renally cleared. Cr within 2-3 years is usually good though unless there are risk factors. For TCAs, I also check an EKG. For topiramate I check a bicarb beforehand. I don't prescribe long term opioids. Don't routinely recheck labs/EKG though. Curious what others do.

 

[Ferrismonk]

Tricyclics: None
SNRIs: None
Gaba/pregaba: None. Will decrease dose if elderly or impaired kidney function known.
Tizanidine/metho/cyclobenzaprine/baclofen: Monitor LFTS for tizanidine
Topiramate: Nothing, but I rarely prescribe this.
Opioids: UDS obviously. I don't check hormones routinely, but do inform of risk of lower testosterone and sex drive. Might check T during course of therapy, but usually will turf to PCP. EKG for methadone.
NSAIDs: I don't usually prescribe these, but will warn about kidney function if taking.

 

[Ducttape]

duloxetine - renal function before initiation usually just looking at prior GFR. will order if none in chart.
gabapentin - renal function before initiation, again by looking for recent GFR.
carbamazapine - drug levels
opioids - UDS, ethyl glucoronide, occasional testoterone level.

additionally:
tricyclics - usually stop at age 60.

 

[macman]

Tricyclics: caution in 55+ pts, if used in older pts check ECG prior to assess for heart block, if the patient has a pre-existing mild heart block, could cause worsening

SNRIs: monitor Liver >> kidneys. LFTs at about 4-6 weeks and q 6-12 months. also Relative contraindication patients are anticoagulated. Assess for severe glaucoma and history of liver issues prior to initiating

Gaba/pregaba: GFR and renal dose

Tizanidine/metho/cyclobenzaprine/baclofen: don't use these much, CMP should cover if h/o signif. medical issues

Topiramate: CMP

Opioids: usual stuff. don't start without an exit strategy