Perphenazine

Perphenazine is a prescription medication used to treat schizophrenia and to control severe nausea and vomiting in adults. Perphenazine belongs to a group of drugs called first generation or "typical" antipsychotics. The exact way it works is unknown, however it is thought to work by affecting certain chemicals in the brain.

Perphenazine comes in tablet form. It is usually taken 2 to 4 times daily.

Common side effects include dry mouth, blurred vision, drowsiness, and dizziness. Do not drive or operate heavy machinery until you know how it affects you.

Perphenazine is a prescription medication used to treat schizophrenia and to control severe nausea and vomiting in adults. 

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Perphenazine may be found in some form under the following brand names:

• Etrafon

• Triavil

• Trilafon

Common side effects include:

• drowsiness
• dizziness
• blurred vision
• dry mouth
• excess saliva
• stuffed nose
• headache
• nausea
• vomiting
• diarrhea
• constipation
• loss of appetite
• unusual, slowed, or uncontrollable movements of any part of the body
• restlessness
• difficulty falling asleep or staying asleep
• difficult or frequent urination
• breast enlargement
• breast milk production
• impotence

This is not a complete list of perphenazine side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• tricyclic antidepressants such as trimipramine (Surmontil), amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl), protriptyline (Vivactil), and clomipramine (Anafranil)

• selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), sertraline (Zoloft), citalopram (Celexa), vilazodone (Viibryd), paroxetine (Paxil), fluoxetine (Prozac, Sarafem, Symbyax), and fluvoxamine (Luvox)
• medications that block a protein in the body (CYP2D6) such as quinidine (Qualaquin)
• atropine
• other central nervous system depressants such as opiates, analgesics, antihistamines, and barbiturates

This is not a complete list of perphenazine drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with perphenazine including the following:

• Neuroleptic malignant syndrome (NMS). Neuroleptic Malignant Syndrome (NMS) is a rare and potentially fatal side effect reported with risperidone injectable and similar medicines. Call your doctor immediately if the person being treated develops symptoms such as high fever; stiff muscles; shaking; confusion; sweating; changes in pulse, heart rate, or blood pressure; or muscle pain and weakness. Treatment should be stopped if the person being treated has NMS.
• Dystonia. Dystonia is a movement disorder that causes involuntary contractions of your muscles.
• Extrapyramidal Reactions. Extrapyramidal Symptoms (EPS) are usually persistent movement disorders or muscle disturbances, such as restlessness, tremors, and muscle stiffness. If you observe any of these symptoms, talk to your healthcare professional.
• Tardive dyskinesia. Tardive Dyskinesia (TD) is a serious, sometimes permanent side effect reported with risperidone injectable and similar medications. TD includes uncontrollable movements of the face, tongue, and other parts of the body. The risk of developing TD and the chance that it will become permanent is thought to increase with the length of therapy and the overall dose taken by the patient. This condition can develop after a brief period of therapy at low doses, although this is much less common. There is no known treatment for TD, but it may go away partially or completely if therapy is stopped.
• Elevated prolactin levels. Tell your healthcare provider right away if you have some or all of the following symptoms of elevated prolactin levels.
  • Breast milk production that is not related to childbirth (galactorrhea)
  • lack of a period
  • growth of abnormally large breasts in males
  • impotence
• Rise in body temperature.
• Changes in blood counts. Your doctor will do blood tests as needed to check your blood cell counts.
• Changes in liver and kidney function. Your doctor will do blood tests as needed to check your liver and kidney function.

Perphenazine can cause drowsiness. Do not drive or operate heavy machinery until you know how perphenazine affects you.

Perphenazine can predispose you to sunburn. Use a sunscreen, and avoid excessive exposure to sunlight.

Do not take perphenazine if you:

• are allergic to perphenazine or to any of its ingredients
• are receiving large doses of central nervous system depressants (barbiturates, alcohol, narcotics, analgesics, or antihistamines)
• have blood dyscrasias (blood diseases)
• in a coma or unconscious
• have bone marrow depression
• have liver damage
• have brain damage

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of perphenazine, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking perphenazine, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to perphenazine or to any of its ingredients
• have had an adverse reaction to to other phenothiazines
• are pregnant or breastfeeding
• have reduced renal function
• are going to have surgery
• have depression
• have seizures

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

Safe use of perphenazine during pregnancy has not been established. Perphenazine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Tell your doctor if you are breastfeeding or plan to breastfeed.

Safe use of perphenazine during lactation has not been established. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using perphenazine.

Take perphenazine exactly as prescribed.

Perphenazine comes in tablet form and is taken up to four times every day, with or without food.

The use of alcohol should be avoided, since additive effects and low blood pressure may occur. Patients should be cautioned that their response to alcohol may be increased while they are being treated with perphenazine. The risk of suicide and the danger of overdose may be increased in patients who use alcohol excessively due to its potentiation of the drug’s effect.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of perphenazine at the same time.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• the severity of the condition
• other medical conditions you have
• how you respond to this medication
• other medications you are taking
• age
• your renal function

The recommended dose ranges of perphenazine are the following:

Moderately disturbed nonhospitalized patients with schizophrenia:

4 to 8 mg t.i.d. initially; reduce as soon as possible to minimum effective dosage.

Hospitalized patients with schizophrenia:

8 to 16 mg daily in divided doses; 24 mg occasionally may be necessary

If you take too much perphenazine, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Store perphenazine at 20° – 25°C (68° – 77°F).
• Keep this and all medicines out of the reach of children.

WARNING

Increased Mortality in Elderly Patients with Dementia-Related Psychosis

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Perphenazine is not approved for the treatment of patients with dementia-related psychosis.