Assessment

• Monitor blood pressure periodically. Assess patient for drug-induced orthostatic hypotension

» Monitor vital signs and mental status periodically during first few days of dosage adjustment in patients receiving >200 mg daily; side effects are more likely

» Assess for CHF (peripheral edema, weight gain, dyspnea, rales/crackles, jugular venous distention), especially in patients on chronic therapy or with a history of CHF

» Assess patient for the appearance of a diffuse red mottling of the skin (livedo reticularis), especially in the lower extremities or on exposure to cold. Disappears with continued therapy but may not completely resolve until 2–12 wk after therapy has been discontinued

» Geri: Monitor intake and output closely in geriatric patients. May cause urinary retention. Report significant discrepancy or bladder distention

• Assess akinesia, rigidity, tremors, and gait disturbances before and throughout therapy

• Monitor respiratory status (rate, breath sounds, sputum) and temperature periodically. Supportive treatment is indicated if symptoms occur

• Symptoms of toxicity include CNS stimulation (confusion, mood changes, tremors, seizures, arrhythmias, and hypotension). There is no specific antidote, although physostigmine has been used to reverse CNS effects

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