Perphenazine

What is Perphenazine?

• Perphenazine (Trilafon) is a piperazinyl phenothiazine, used to treat the symptoms of schizophrenia.
• It is also used to control severe nausea and vomiting in adults.

Perphenazine

Perphenazine3Dan2

Perphenazine2D

What are the uses of this medicine?

• Perphenazine (Trilafon) is used for treatment of schizophrenia and for the control of severe nausea and vomiting in adults.

limitations of use:

• Perphenazine has not been shown effective for the management of behavioral complications in patients with mental retardation.

How does this medicine work?

• Perphenazine (per fen' a zeen) is a piperazine phenothiazine derivative which acts by postsynaptic inhibition of dopamine receptors.
• Perphenazine has other peripheral and central nervous system effects, producing both alpha adrenergic stimulation and blocking histamine- and serotonin-mediated effects.

Who Should Not Use this medicine ?

This medicine cannot be used in:

• comatose or greatly obtunded patients.
• patients receiving large doses of central nervous system depressants (barbiturates, alcohol, narcotics, analgesics, or antihistamines)
• the presence of existing blood dyscrasias, bone marrow depression, or liver damage
• who have shown hypersensitivity to perphenazine products, their components, or related compounds.
• in patients with suspected or established subcortical brain damage, with or without hypothalamic damage.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• amiodarone (Cordarone, Pacerone); antidepressants; antihistamines; atropine (in Motofen, in Lomotil, in Lonox); barbiturates such as pentobarbital (Nembutal), phenobarbital (Luminal), and secobarbital (Seconal); bupropion (Aplenzin, Wellbutrin, Zyban); chlorpheniramine (in cough and cold medications); cimetidine (Tagamet); clomipramine (Anafranil); duloxetine (Cymbalta); epinephrine (Epipen); haloperidol (Haldol); ipratropium (Atrovent); medications for anxiety or mental illness, irritable bowel disease, motion sickness, Parkinson's disease, seizures, ulcers, or urinary problems; methadone (Dolophine); narcotic medications for pain; quinidine; ritonavir (Norvir, in Kaletra); sedatives; certain selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft); sleeping pills; and tranquilizers.

Is this medicine FDA approved?

• Perphenazine is indicated for the therapy of acute and chronic psychosis and is also used for management of nausea and vomiting.
• Perphenazine was approved for use in the United States in 1957 and was formerly a commonly prescribed antipsychotic, but in recent years, has been replaced in large part by the atypical antipsychotics, which have fewer extrapyramidal side effects.

How should this medicine be used?

Recommended dosage: 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 b.i.d. to q.i.d.; avoid dosages in excess of 64 mg daily.

Severe nausea and vomiting in adults:

• 8 to 16 mg daily in divided doses; 24 mg occasionally may be necessary, early dosage reduction is desirable.

Elderly Patients:

• Geriatric dosages of perphenazine preparations have not been established, but initiation of lower dosages is recommended.

Administration:

• Perphenazine comes as a tablet to take by mouth.
• It is usually taken two to four times a day.
• Take perphenazine at around the same times every day.
• Your doctor may start you on an average dose of perphenazine and decrease your dose once your symptoms are controlled.
• Be sure to tell your doctor how you are feeling during your treatment with perphenazine.
• Perphenazine may help to control your symptoms but will not cure your condition.
• Continue to take perphenazine even if you feel well.
• Do not stop taking perphenazine without talking to your doctor.
• If you suddenly stop taking perphenazine, you may experience withdrawal symptoms such as nausea, vomiting, stomach pain, dizziness, and shakiness.
• Your doctor will probably decrease your dose gradually and may prescribe other medication(s) for you to take for several weeks after you stop taking perphenazine.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As oral tablets containing 2 mg, 4 mg, 8 mg, and 16 mg of perphenazine.

This medicine is available in fallowing brand namesː

• Trilafon

What side effects can this medication cause?

The most common side effects of this medicine include:

• drowsiness, dizziness, headache, blurred vision, dry mouth, constipation, tremor, restlessness, muscle spasms and weight gain.

Additional side effects may include:

• Extrapyramidal Reactions
• Dystonia
• Persistent Tardive Dyskinesia
• cerebral edema
• abnormality of cerebrospinal fluid proteins
• convulsive seizures, particularly in patients with EEG abnormalities
• headaches
• Neuroleptic malignant syndrome
• Hyperreflexia
• Autonomic Effects
• Allergic Effects
• Endocrine Effects
• Cardiovascular Effects
• Hematological Effects

What special precautions should I follow?

• Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Fluphenazinehydrochloride is not approved for the treatment of patients with dementia-related psychosis.
• Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with neuroleptic (antipsychotic) drugs. If signs and symptoms of tardive dyskinesia appear in a patient on neuroleptics, drug discontinuation should be considered. However, some patients may require treatment despite the presence of the syndrome.
• A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs.
• The use of this drug may impair the mental and physical abilities required for driving a car or operating heavy machinery.
• Perphenazine tablets may cause somnolence, postural hypotension, motor and sensory instability, which may lead to falls and, consequently, fractures or other injuries.
• Antipsychotic drugs elevate prolactin levels; the elevation persists during chronic administration.
• Patients on large doses of a phenothiazine drug who are undergoing surgery should be watched carefully for possible hypotensive phenomena. Moreover, reduced amounts of anesthetics or central nervous system depressants may be necessary.
• Since phenothiazines and central nervous system depressants (opiates, analgesics, antihistamines, barbiturates) can potentiate each other, less than the usual dosage of the added drug is recommended and caution is advised when they are administered concomitantly.
• Use with caution in patients who are receiving atropine or related drugs because of additive anticholinergic effects
• Use with caution in patients who will be exposed to extreme heat or phosphorus insecticides.
• The use of alcohol should be avoided, since additive effects and hypotension may occur.
• Blood counts and hepatic and renal functions should be checked periodically.
• The use of phenothiazine derivatives in patients with diminished renal function should be undertaken with caution.
• Use with caution in patients suffering from respiratory impairment due to acute pulmonary infections, or in chronic respiratory disorders such as severe asthma or emphysema.
• Gastritis, nausea and vomiting, dizziness, and tremulousness have been reported following abrupt cessation of high-dose therapy. Reports suggest that these symptoms can be reduced by continuing concomitant antiparkinson agents for several weeks after the phenothiazine is withdrawn.
• Because photosensitivity has been reported, undue exposure to the sun should be avoided during phenothiazine treatment.
• Perphenazine can cause mild and transient serum enzyme elevations and is a rare cause of clinically apparent acute and chronic cholestatic liver injury.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• stupor or coma
• convulsive seizures in children
• tachycardia
• prolongation of the QRS or QTc intervals
• atrioventricular block
• torsade de pointes
• ventricular dysrhythmia
• hypotension
• cardiac arrest

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• Treatment is symptomatic and supportive.
• Induction of emesis is not recommended because of the possibility of a seizure, CNS depression, or dystonic reaction of the head or neck and subsequent aspiration.
• Gastric lavage (after intubation, if the patient is unconscious) and administration of activated charcoal together with a laxative should be considered.
• There is no specific antidote.
• Standard measures (oxygen, intravenous fluids, corticosteroids) should be used to manage circulatory shock or metabolic acidosis.
• An open airway and adequate fluid intake should be maintained.
• Body temperature should be regulated.
• Hypothermia is expected, but severe hyperthermia may occur and must be treated vigorously
• An electrocardiogram should be taken and close monitoring of cardiac function instituted if there is any sign of abnormality.
• Close monitoring of cardiac function is advisable for not less than five days.
• Vasopressors such as norepinephrine may be used to treat hypotension, but epinephrine should NOT be used.
• Hemodialysis and peritoneal dialysis are of no value because of low plasma concentrations of the drug.

Can this medicine be used in pregnancy?

• Perphenazine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
• Neonates exposed to antipsychotic drugs, during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery.

Can this medicine be used in children?

• Perphenazine products are not recommended for pediatric patients under 12 years of age.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• perphenazine

Inactive ingredients:

• black iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, sodium starch glycolate, talc, titanium dioxide, yellow iron oxide.

Who manufactures and distributes this medicine?

Dist. by:

• Par Pharmaceutical
• Chestnut Ridge, NY U.S.A.

Mfg. by:

• Par Formulations Private Limited,
• 9/215, Pudupakkam, Kelambakkam.
• Made in India

What should I know about storage and disposal of this medication?

• Store at 20° to 25°C (68° to 77°F).
• Dispense in a tight, light-resistant container.

Antipsychotic agents

First Generation

• Phenothiazines
  • Chlorpromazine, Fluphenazine, Perphenazine, Prochlorperazine, Thioridazine, Trifluoperazine

• Other
  • Haloperidol, Lithium, Loxapine, Molindone, Pimozide

Second Generation (Atypicals)

• Aripiprazole, Asenapine, Brexpiprazole, Cariprazine, Clozapine, Iloperidone, Lurasidone, Olanzapine, Paliperidone, Pimavanserin, Quetiapine, Risperidone, Ziprasidone

• Dailymed label info on Perphenazine
• FDA Perphenazine

Perphenazine Resources
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