Perphenazine

Brand names

• Apo-Perphenazine
• Elavil Plus [CD]
• Entrafon
• Etrafon [CD]
• Etrafon-A [CD]
• Etrafon Forte [CD]
• Perphenazine
• Phenazine
• PMS-Levazine
• PMS-Perphenazine
• Triavil [CD]
• Trilafon

Usage

To treat psychotic conditions (severe mental disorders characterized by distorted thoughts and perceptions, such as schizophrenia). Also used to treat severe nausea and vomiting.

How it works

Perphenazine blocks receptors of dopamine (a chemical that aids in the transmission of nerve impulses) in the central nervous system. Presumably, this produces a tranquilizing or antipsychotic effect.

Side effects

Serious

Rapid heartbeat, profuse sweating, seizures, difficulty breathing, neck stiffness, swelling of the tongue, difficulty swallowing. Also a rare condition can develop called neuroleptic malignant syndrome, characterized by stiffness or spasms of the muscles, high fever, and confusion or disorientation.

Common

Nausea, reduced sweating, dry mouth, blurred vision, drowsiness, shaking of hands, stiffness, stooped posture.

Less common

Difficult urination, menstrual irregularities, breast pain or swelling, unexpected weight gain, uncontrolled movements of the tongue, fever, chills, sore throat, unusual bruising or bleeding, heart palpitations, skin rash, itching, increased sensitivity of the skin to sunlight.

Possible interactions

Other medicaments:

Perphenazine may increase the effects of:

• all atropinelike medicaments and cause nervous system toxicity.
• all sedative medicaments, especially meperidine (Demerol), and cause excessive sedation.

Perphenazine may decrease the effects of:

• guanethidine (Ismelin, Esimil) and reduce its effectiveness in lowering blood pressure.
• oral antidiabetic medicaments and cause loss of glucose control.

Perphenazine taken concurrently with:

• ascorbic acid may blunt the therapeutic effect of perphenazine.
• cisapride (Propulsid) may lead to serious heart rhythm problems.
• dofetilide (Tikosyn) may lead to serious heart rhythm problems.
• fosphenytoin (Cerebyx) or phenytoin (Dilantin) may lead to increased or decreased phenytoin levels or reduced perphenazine levels.
• gatifloxacin (Tequin) , grepafloxacin (Raxar) , moxifloxacin (Avelox)or sparfloxacin (Zagam) may lead to abnormal heartbeats.
• lithium (Lithobid, Lithotabs) may impair the effectiveness of lithium and cause nervous system toxicity.
• monoamine oxidase (MAO) inhibitors may result in increased extrapyramidal reactions.
• ritonavir (Norvir) and perhaps other protease inhibitors may lead to toxicity.
• tramadol (Ultram) may increase seizure risk.

The following medicaments may decrease the effects of perphenazine:

• antacids containing aluminum and/or magnesium.
• barbiturates.
• benztropine (Cogentin).
• disulfiram (Antabuse).
• trihexyphenidyl (Artane).

Foods:

Vitamin E may help reduce risk of movement disorders. Excessive vitamin C may blunt benefits.

Herbal medicines or minerals:

Since perphenazine and St. John's wort may act to increase sensitivity to the sun, the combination is not advised. Since part of the way ginseng works may be as a MAO inhibitor, do not combine ginseng with perphenazine. Kava and valerian may worsen drowsiness. Aluminum - or magnesium - containing antacids may decrease absorption.
A riboflavin (vitamin B2) supplement should be taken with long-term use. Vitamin E may lower risk of movement disorders.

Alcohol:

Alcohol can increase the sedative action of phenothiazines and accentuate their depressant effects on brain function and blood pressure. Phenothiazines can increase the intoxicating effects of alcohol.

Tobacco smoking:

Possible reduction of drowsiness from medicament.

Marijuana smoking:

Moderate increase in drowsiness; accentuation of orthostatic hypotension; increased risk of precipitating latent psychoses, confusing the interpretation of mental status and medicament responses.

Exposure to sun:

Use caution-some phenothiazines can cause photosensitivity.

Exposure to heat:

Use caution and avoid excessive heat as much as possible. This medicament may impair the regulation of body temperature and increase the risk of heatstroke.

Exposure to cold:

This medicament can increase the risk of hypothermia in the elderly.

Discontinuation:

After a period of long-term use, do not stop this medicament suddenly. Gradual withdrawal over 2 to 3 weeks under physician supervision is recommended. Schizophrenia relapse is 50-60%.

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