Medication Lab Monitoring

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Showing 59 of 59 medications

ACE inhibitors / ARBs

Lisinopril, Zestril, Enalapril, Ramipril, Losartan, Cozaar, Valsartan, Diovan, Olmesartan, BenicarCardiac

Lab	Baseline	Frequency
BMP (Cr + K+)	✓	1–2 wk after initiation or dose change, then at least annually

Source: KDIGO; ACC/AHA

Acitretin

SoriataneDerm

Lab	Baseline	Frequency
LFTs	✓	q2–4 wk × 2 mo, then q3 mo
Lipid panel	✓	q2–4 wk × 2 mo, then q3 mo
Pregnancy test (hCG)	✓	Monthly during therapy and q3 mo for 3 years after stopping

Source: AAD; FDA labeling

Allopurinol

Zyloprim, AloprimRheum/Immunosuppressant

Lab	Baseline	Frequency
Uric acid	✓	q2–5 wk during titration, then q6 mo once at target
Cr / eGFR	✓	Periodically
HLA-B*58:01	✓	Once before initiation in high-risk ancestry (Han Chinese, Korean with CKD, Thai)
LFTs	✓	Periodically

Source: ACR 2020 gout guideline

Aminoglycosides

Gentamicin, Tobramycin, AmikacinInfectious Disease

Lab	Baseline	Frequency
Peak / trough levels	—	Per protocol (extended-interval: random level with nomogram)
Cr	✓	q2–3 d during therapy

Source: IDSA

Amiodarone

Pacerone, CordaroneCardiac

Lab	Baseline	Frequency
TSH	✓	Baseline, then q6 mo
LFTs	✓	Baseline, then q6 mo

Source: ACC/AHA/HRS; package insert

Amphotericin B

AmBisome, AbelcetInfectious Disease

Lab	Baseline	Frequency
Cr	✓	Daily to q2–3 d during therapy
K+ / Mg	✓	Same schedule as Cr
CBC	✓	Weekly

Source: IDSA

Atypical antipsychotics

Olanzapine, Zyprexa, Quetiapine, Seroquel, Risperidone, Risperdal, Aripiprazole, Abilify, Ziprasidone, GeodonPsych

Lab	Baseline	Frequency
A1c / Glucose	✓	12 wk after initiation, then annually
Lipid panel	✓	12 wk after initiation, then q5 y (annually if abnormal)
Prolactin	—	Only if symptoms (galactorrhea, amenorrhea, sexual dysfunction)

Source: ADA/APA consensus statement

Azathioprine

Imuran, AzasanRheum/Immunosuppressant

Lab	Baseline	Frequency
TPMT / NUDT15	✓	Once before initiation
CBC	✓	q1–2 wk during titration, then q3 mo
LFTs	✓	q3 mo

Source: ACR; AGA IBD guidance

Carbamazepine

Tegretol, Carbatrol, EquetroAnticonvulsant

Lab	Baseline	Frequency
Carbamazepine level	—	Trough at steady state; recheck ~4–6 wk after start (autoinduction), then as needed
CBC	✓	q3–6 mo for the first year, then annually
Sodium	✓	Periodically, and if confusion/lethargy
LFTs	✓	Periodically
HLA-B*15:02	✓	Once before initiation in patients of Asian ancestry

Source: AAN; FDA labeling

Clozapine

Clozaril, VersaclozPsych

Lab	Baseline	Frequency
ANC	✓	Weekly × 6 mo, then q2 wk × 6 mo, then monthly (REMS schedule)
A1c / Lipids / Weight	✓	q3 mo first year, then annually
Troponin / CRP	—	Weekly × first 4 wk if myocarditis suspected or per local protocol

Source: FDA Clozapine REMS; APA

Colchicine

Colcrys, MitigareRheum/Immunosuppressant

Lab	Baseline	Frequency
Cr / eGFR	✓	Periodically with chronic use
CBC	—	Periodically with long-term prophylaxis
CK	—	If muscle symptoms, especially with statin co-therapy

Source: ACR; FDA labeling

Combined oral contraceptives

Sprintec, Yaz, Lo Loestrin, JunelEndocrine

Lab	Baseline	Frequency
None routinely	—	No routine labs in healthy users

Source: CDC US MEC

Cyclosporine

Neoral, Sandimmune, GengrafRheum/Immunosuppressant

Lab	Baseline	Frequency
Cyclosporine trough	—	q1–2 wk early, then q1–3 mo when stable
Cr	✓	With each level check
K+ / Mg / Uric acid	✓	Periodically
Lipid panel	✓	Periodically

Source: KDIGO

Digoxin

Lanoxin, DigitekCardiac

Lab	Baseline	Frequency
Digoxin level	—	1–2 wk after initiation or dose change (≥6 h post-dose), then if toxicity suspected or renal function changes
BMP (K+, Cr)	✓	q6–12 mo, sooner with diuretic changes or acute illness

Source: AHA/HRS; ACC HF guidance

DOACs

Apixaban, Eliquis, Rivaroxaban, Xarelto, Dabigatran, Pradaxa, Edoxaban, SavaysaAnticoagulant

Lab	Baseline	Frequency
Cr / eGFR	✓	At least annually; q6 mo if CrCl <60, sooner with acute illness
CBC	✓	Annually
LFTs	✓	Annually

Source: ACC 2017 expert consensus; ISTH

Ezetimibe

ZetiaLipid

Lab	Baseline	Frequency
Lipid panel	✓	4–12 wk after initiation, then q3–12 mo
LFTs	✓	Baseline when combined with a statin; repeat only if symptoms

Source: ACC/AHA 2018 cholesterol guideline

Febuxostat

UloricRheum/Immunosuppressant

Lab	Baseline	Frequency
Uric acid	✓	During titration, then q6 mo
LFTs	✓	Periodically

Source: ACR 2020 gout guideline; FDA

Fibrates

Fenofibrate, Tricor, Gemfibrozil, LopidLipid

Lab	Baseline	Frequency
LFTs	✓	Baseline, then periodically during therapy
Creatinine	✓	Within 3 mo of initiation, then periodically
CK	—	Only if muscle symptoms

Source: FDA labeling

Finasteride / Dutasteride

Proscar, Propecia, AvodartEndocrine

Lab	Baseline	Frequency
PSA	✓	Baseline and 6–12 mo, then per screening schedule

Source: AUA

Fluconazole / azoles (prolonged)

Diflucan, Itraconazole, Sporanox, Voriconazole, VfendInfectious Disease

Lab	Baseline	Frequency
LFTs	✓	Periodically with prolonged courses

Source: IDSA

GLP-1 receptor agonists

Semaglutide, Ozempic, Wegovy, Liraglutide, Victoza, Dulaglutide, Trulicity, Tirzepatide, Mounjaro, ZepboundDiabetes

Lab	Baseline	Frequency
A1c	✓	q3 mo until at goal, then q6 mo
Lipase	—	Only if persistent severe abdominal pain — routine monitoring not recommended

Source: ADA Standards of Care 2025

Heparin (unfractionated)

UFHAnticoagulant

Lab	Baseline	Frequency
aPTT or anti-Xa	✓	q6 h until therapeutic, then daily (therapeutic dosing)
Platelets	✓	q2–3 d from day 4 to day 14
Hemoglobin	✓	Periodically during therapy

Source: ACCP CHEST guidelines

Hydroxychloroquine

PlaquenilRheum/Immunosuppressant

Lab	Baseline	Frequency
CBC / LFTs / Cr	✓	Baseline, then periodically

Source: AAO 2016 retinopathy screening; ACR

Insulin (all types)

Lantus, Basaglar, Tresiba, Levemir, Humalog, Novolog, Lispro, Aspart, Glargine, DegludecDiabetes

Lab	Baseline	Frequency
A1c	✓	q3 mo until at goal, then q6 mo
Glucose (SMBG/CGM)	—	Daily self-monitoring or CGM, intensified during titration
Potassium	—	Only with IV insulin or DKA management

Source: ADA Standards of Care 2025

Isoniazid

INHInfectious Disease

Lab	Baseline	Frequency
LFTs	✓	Baseline for all; monthly if risk factors (age >35, alcohol, liver disease, pregnancy/postpartum, HIV) or symptoms

Source: ATS/CDC latent TB guidance

Isotretinoin

Accutane, Absorica, ClaravisDerm

Lab	Baseline	Frequency
LFTs	✓	Monthly until stable on final dose, then as needed
Lipid panel (fasting)	✓	Monthly until stable, then as needed
Pregnancy test (hCG)	✓	Monthly before each refill (iPLEDGE)

Source: AAD; iPLEDGE REMS

Lamotrigine

LamictalAnticonvulsant

Lab	Baseline	Frequency
Lamotrigine level	—	Optional; check in pregnancy (clearance rises markedly) or with interacting drug changes (valproate, estrogen, enzyme inducers)

Source: AAN; FDA labeling

Leflunomide

AravaRheum/Immunosuppressant

Lab	Baseline	Frequency
LFTs	✓	Monthly × 6 mo, then q8 wk
CBC	✓	Monthly × 6 mo, then q8 wk
Cr	✓	Periodically

Source: ACR; FDA labeling

Levetiracetam

KeppraAnticonvulsant

Lab	Baseline	Frequency
Cr / eGFR	✓	Periodically

Source: AAN

Levothyroxine

Synthroid, Levoxyl, Tirosint, UnithroidEndocrine

Lab	Baseline	Frequency
TSH	✓	6–8 wk after initiation or dose change, then annually once stable

Source: ATA 2014 hypothyroidism guideline

Lithium

Lithobid, EskalithPsych

Lab	Baseline	Frequency
Lithium level	—	5–7 d after initiation or dose change (12 h post-dose trough), then q3–6 mo
TSH	✓	q6–12 mo
Cr / eGFR	✓	q6–12 mo
Calcium	✓	Annually

Source: APA; VA/DoD bipolar guideline

LMWH (enoxaparin)

Lovenox, EnoxaparinAnticoagulant

Lab	Baseline	Frequency
Platelets	✓	Periodically days 4–14 if prior heparin exposure
Anti-Xa	—	Only in renal failure, pregnancy, extremes of weight (peak 4 h post-dose)
Cr / eGFR	✓	Baseline, then with clinical change

Source: ACCP CHEST guidelines

Loop diuretics

Furosemide, Lasix, Torsemide, Bumetanide, BumexRenal/Diuretic

Lab	Baseline	Frequency
BMP (K, Mg, Cr)	✓	1–2 wk after initiation or dose change, then q3–6 mo

Source: ACC/AHA HF guideline

Metformin

Glucophage, Fortamet, GlumetzaDiabetes

Lab	Baseline	Frequency
Cr / eGFR	✓	At least annually; q3–6 mo if eGFR 30–60
Vitamin B12	—	q2–3 y with long-term use, or if anemia/neuropathy
A1c	✓	q3 mo until at goal, then q6 mo

Source: ADA Standards of Care 2025

Methimazole

TapazoleEndocrine

Lab	Baseline	Frequency
TSH / Free T4	✓	q4–6 wk until euthyroid, then q3 mo
CBC	✓	Baseline, then immediately if fever or sore throat
LFTs	✓	Baseline, then if jaundice, dark urine, or abdominal pain

Source: ATA 2016 hyperthyroidism guideline

Methotrexate (low-dose)

Trexall, Otrexup, RasuvoRheum/Immunosuppressant

Lab	Baseline	Frequency
CBC	✓	q2–4 wk × 3 mo, then q8–12 wk × 3–6 mo, then q12 wk
LFTs	✓	Same schedule as CBC
Cr / eGFR	✓	Same schedule as CBC
Hepatitis B/C serologies	✓	Once before initiation

Source: ACR 2008/2021 RA guidelines

Niacin (lipid-dose)

NiaspanLipid

Lab	Baseline	Frequency
LFTs	✓	Baseline, then q6 mo
Glucose / A1c	✓	Periodically, especially in diabetes or prediabetes
Uric acid	✓	Periodically if gout history

Source: FDA labeling

Nitrofurantoin (chronic suppression)

Macrobid, MacrodantinInfectious Disease

Lab	Baseline	Frequency
LFTs	✓	Periodically with chronic use
Cr / eGFR	✓	Annually
CBC	—	Periodically

Source: AGS Beers criteria; FDA labeling

PCSK9 inhibitors

Evolocumab, Repatha, Alirocumab, PraluentLipid

Lab	Baseline	Frequency
Lipid panel	✓	4–12 wk after initiation, then q3–12 mo

Source: ACC/AHA 2018 cholesterol guideline

Phenytoin

Dilantin, PhenytekAnticonvulsant

Lab	Baseline	Frequency
Phenytoin level	—	Trough at steady state, then with dose changes, interactions, or toxicity signs; correct for albumin
CBC / LFTs	✓	Periodically
Vitamin D	—	q1–2 y with long-term use

Source: AAN; FDA labeling

Pioglitazone

ActosDiabetes

Lab	Baseline	Frequency
LFTs	✓	Baseline, then periodically
A1c	✓	q3 mo until at goal, then q6 mo

Source: ADA 2025; FDA labeling

PPIs (long-term)

Omeprazole, Prilosec, Pantoprazole, Protonix, Esomeprazole, Nexium, Lansoprazole, PrevacidGI

Lab	Baseline	Frequency
Magnesium	—	Periodically with use >1 y, or if on digoxin/diuretics
Vitamin B12	—	q2–3 y with long-term use

Source: AGA; FDA safety communications

Rifampin

RifadinInfectious Disease

Lab	Baseline	Frequency
LFTs	✓	Periodically during therapy
CBC	✓	Periodically

Source: ATS/CDC

Sacubitril/Valsartan

EntrestoCardiac

Lab	Baseline	Frequency
BMP (Cr + K+)	✓	1–2 wk after each titration step, then periodically

Source: ACC/AHA HF 2022

SGLT2 inhibitors

Empagliflozin, Jardiance, Dapagliflozin, Farxiga, Canagliflozin, InvokanaDiabetes

Lab	Baseline	Frequency
Cr / eGFR	✓	Baseline, then at least annually
A1c	✓	q3 mo until at goal, then q6 mo
Potassium	✓	Periodically if CKD or on RAAS inhibitors

Source: ADA Standards of Care 2025

Spironolactone / Eplerenone

Aldactone, CaroSpir, InspraRenal/Diuretic

Lab	Baseline	Frequency
Potassium	✓	Within 1 wk of initiation or dose change, then q3–6 mo
Creatinine	✓	Same schedule as potassium

Source: ACC/AHA HF guideline; RALES protocol

SSRIs / SNRIs

Sertraline, Zoloft, Escitalopram, Lexapro, Fluoxetine, Prozac, Citalopram, Celexa, Venlafaxine, Effexor, Duloxetine, CymbaltaPsych

Lab	Baseline	Frequency
Sodium	—	Within 2–4 wk of initiation in elderly or diuretic-treated patients, or if confusion/falls

Source: Maudsley guidelines; FDA labeling

Statins

Atorvastatin, Lipitor, Rosuvastatin, Crestor, Simvastatin, Zocor, Pravastatin, PravacholLipid

Lab	Baseline	Frequency
Lipid panel	✓	4–12 wk after initiation or dose change, then q3–12 mo
LFTs	✓	Baseline only; repeat only if hepatotoxicity symptoms
CK	—	Only if muscle symptoms (not routine)

Source: ACC/AHA 2018 cholesterol guideline

Sulfasalazine

AzulfidineRheum/Immunosuppressant

Lab	Baseline	Frequency
CBC	✓	q2–4 wk × 3 mo, then q3 mo
LFTs	✓	Same schedule as CBC
G6PD	✓	Once before initiation in at-risk ancestry

Source: ACR

Sulfonylureas

Glipizide, Glucotrol, Glimepiride, Amaryl, GlyburideDiabetes

Lab	Baseline	Frequency
A1c	✓	q3 mo until at goal, then q6 mo
Glucose (SMBG)	—	Home monitoring, especially with dose changes or reduced intake
Cr / eGFR	✓	Annually

Source: ADA Standards of Care 2025

Tacrolimus

Prograf, Envarsus XRRheum/Immunosuppressant

Lab	Baseline	Frequency
Tacrolimus trough	—	q1–2 wk early post-initiation, then q1–3 mo when stable
Cr + K+	✓	With each level check
Glucose / A1c	✓	q3 mo
Magnesium	✓	Periodically

Source: KDIGO transplant guideline

Terbinafine (oral)

LamisilDerm

Lab	Baseline	Frequency
LFTs	✓	Baseline; consider repeat at 4–6 wk of therapy
CBC	—	If therapy >6 wk

Source: FDA labeling; AAD

Testosterone

AndroGel, Testim, Depo-Testosterone, Xyosted, JatenzoEndocrine

Lab	Baseline	Frequency
Total testosterone	✓	3–6 mo after initiation (timing depends on formulation), then annually
Hematocrit	✓	3–6 mo after initiation, then annually
PSA	✓	3–12 mo after initiation, then per age-appropriate screening (men ≥40–50)

Source: Endocrine Society 2018

Thiazide diuretics

Hydrochlorothiazide, HCTZ, Microzide, Chlorthalidone, IndapamideRenal/Diuretic

Lab	Baseline	Frequency
BMP (Na, K)	✓	2–4 wk after initiation or dose change, then annually
Glucose / Uric acid	✓	Periodically, especially with diabetes or gout history

Source: ACC/AHA HTN guideline

TMP-SMX (chronic/prophylactic)

Bactrim, SeptraInfectious Disease

Lab	Baseline	Frequency
CBC	✓	q3 mo with chronic use
K+ / Cr	✓	1–2 wk after start if CKD, elderly, or on RAAS inhibitors; then periodically

Source: IDSA; FDA labeling

TNF inhibitors (biologics)

Adalimumab, Humira, Etanercept, Enbrel, Infliximab, Remicade, Golimumab, CertolizumabRheum/Immunosuppressant

Lab	Baseline	Frequency
TB test (IGRA/PPD)	✓	Before initiation, then annually if ongoing exposure risk
Hepatitis B serologies	✓	Once before initiation
CBC / LFTs	✓	q3–6 mo

Source: ACR

Valproate / Divalproex

Depakote, DepakeneAnticonvulsant

Lab	Baseline	Frequency
Valproate level	—	Trough at steady state (3–5 d), then as needed for seizures/toxicity/adherence
LFTs	✓	Frequently during first 6 mo, then q6 mo
CBC with platelets	✓	q6 mo and before surgery
Ammonia	—	Only if altered mental status

Source: AAN; FDA labeling

Vancomycin (IV)

VancocinInfectious Disease

Lab	Baseline	Frequency
Trough / AUC	—	Before 4th dose, then per protocol (AUC/MIC 400–600 preferred)
Cr	✓	q2–3 d inpatient, more often if unstable
CBC	—	Weekly if therapy prolonged (>2 wk)

Source: IDSA/ASHP 2020 vancomycin guideline

Warfarin

Coumadin, JantovenAnticoagulant

Lab	Baseline	Frequency
INR	✓	q2–3 d at initiation, then q4 wk once stable (up to q12 wk if consistently stable)
CBC	✓	Baseline, then if bleeding signs

Source: ACCP CHEST guidelines