How should orthostatic hypotension be managed in patients starting antipsychotics?

• A. Start with high doses and titrate quickly; monitor blood pressure only at baseline.
• B. Start with low doses and titrate slowly; monitor blood pressure with position changes; advise standing up gradually and ensure hydration.
• C. Do not monitor blood pressure unless symptoms occur; continue to medication as planned.
• D. Use anticonvulsant co-therapy to prevent orthostatic hypotension.

Answer: (B)

Managing orthostatic hypotension in patients starting antipsychotics means starting with a low dose and titrating slowly, actively monitoring blood pressure as the patient changes posture, and supporting hydration and gradual position changes. Antipsychotics can cause orthostatic hypotension because they block alpha-1 receptors, leading to vasodilation and reduced venous return when moving upright. A slow uptitration minimizes peak drug effects on the vessels, lowering the risk of a significant drop in blood pressure. Checking blood pressure in multiple positions detects orthostatic changes early, rather than waiting for symptoms alone. Teaching patients to rise gradually and ensure adequate hydration helps maintain cerebral perfusion and reduces dizziness or fainting. If necessary, dose adjustments or choosing an agent with less orthostatic risk can be considered; however, adding anticonvulsants to prevent orthostatic hypotension is not appropriate.