arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. perphenazine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)perphenazine and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (2)perphenazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. perphenazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).zolpidemMonitor Closely (1)perphenazine will increase the level or effect of zolpidem by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Additive effect of decreased alertness and psychomotor performancezotepineMonitor Closely (2)perphenazine and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. perphenazine and zotepine both increase sedation. Use Caution/Monitor. >10% Akathisia (60%) Frequency Not Defined Confusion Decreased gag reflex EPS Akathisia (60%) Dystonia Muscle stiffness Neuroleptic malignant syndrome (infrequent but serious) Parkinsonism Tardive dyskinesia Common Anticholinergic effects Sedation Weight gain Oligomenorrhea/amenorrhea Erectile dysfunction Less Common Orthostatic hypotension (post-IM inj), tachycardia Anxiety, agitation, cerebral edema, depression, dizziness, euphoria, headache, insomnia, restless, weakness Anorexia, dyspepsia, constipation, ileus Lens opacities (prolonged use) Uncommon ECG changes Photosensitivity Pruritis Galactorrhea Ejaculatory disorder Diarrhea Blood dyscrasia Rare Seizure Priapism Cholestatic jaundice Black Box Warnings Patients with dementia-related psychosis who are treated with antipsychotic drugs are at an increased risk of death as shown in short-term controlled trials. The deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature This drug is not approved for the treatment of patients with dementia-related psychosisContraindications Documented hypersensitivity to phenothiazines Coma, severe hypotension, severe CNS depression, concurrency with large amounts of CNS depressants, poorly controlled seizure disorder, subcortical brain damage with or without hypothalamic damage, myelosuppression, liver damage, blood dyscrasias Severe cardiovascular disease Lactation Cautions Avoid using in children with suspected Reye's syndrome Use caution in prostatic hypertrophy, stenosing PUD, tardive dyskinesia, hypocalcemia, renal/hepatic impairment, patients who have exhibited a severe reaction to insulin or ECT, history of seizures, asthma, respiratory tract infections, cardiovascular disease Perphenazine products can lower convulsive threshold in susceptible individuals; they should be used with caution in alcohol withdrawal and in patients with convulsive disorders; if patient is being treated with an anticonvulsant agent, increased dosage of that agent may be required when perphenazine products are used concomitantly Should be used with caution in patients with psychiatric depression; possibility of suicide in depressed patients remains during treatment and until significant remission occurs; this type of patient should not have access to large quantities of this drug Caution should be observed in giving it to patients who have previously exhibited severe adverse reactions to other phenothiazines some of the untoward actions of perphenazine tend to appear more frequently when high doses are used; patients should be kept under close supervision A significant, not otherwise explained, rise in body temperature may suggest individual intolerance to perphenazine, in which case it should be discontinued Patients on large doses who are undergoing surgery should be watched carefully for possible hypotensive phenomena; reduced amounts of anesthetics or central nervous system depressants may be necessary If abnormalities in hepatic tests occur, phenothiazine treatment should be discontinued Renal function in patients on long-term therapy should be monitored; if blood urea nitrogen (BUN) becomes abnormal, treatment should be discontinued 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 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 drug is withdrawn Possibility of liver damage, corneal and lenticular deposits, and irreversible dyskinesias should be considered when patients are on long-term therapy Because photosensitivity has been reported, undue exposure to sun should be avoided during phenothiazine treatment Leukopenia and neutropenia Events of leukopenia/neutropenia and agranulocytosis reported Possible risk factors include preexisting low white blood cell count (WBC) and history of drug induced leukopenia/neutropenia Patients with a preexisting low WBC or a history of drug induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during first few months of therapy discontiue at first sign of a decline in WBC in absence of other causative factors Blood counts should be checked periodically; appearance of signs of blood dyscrasias requires discontinuance of drug and institution of appropriate therapy Tardive dyskinesia Risk of developing the syndrome and likelihood that it will become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic drugs administered to the patient increase; however, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses Antipsychotics should be prescribed in manner that is most likely to minimize occurrence of tardive dyskinesia Chronic antipsychotic treatment should generally be reserved for patients who suffer from chronic illness that 1) is known to respond to antipsychotic drugs, and 2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate In patients who require chronic treatment, the smallest dose and shortest duration of treatment producing a satisfactory clinical response should be sought; the need for continued treatment should be reassessed periodically If signs and symptoms of tardive dyskinesia appear in a patient on antipsychotics, drug discontinuation should be considered; however, some patients may require treatment despite presence of the syndrome Neuroleptic malignant syndrome Neuroleptic malignancy syndrome (NMS) may occur; clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmias) Management of NMS should include 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring, and 3) treatment of any concomitant serious medical problems for which specific treatments are available There is no general agreement about specific pharmacologic treatment regimens for uncomplicated NMS If a patient requires antipsychotic drug treatment after recovery from NMS, reintroduction of drug therapy should be carefully considered; patient should be carefully monitored; recurrences reported If hypotension develops, epinephrine should not be administered since its action is blocked and partially reversed If a vasopressor is needed, norepinephrine or dopamine may be used Severe, acute hypotension has occurred with use of phenothiazines and is particularly likely to occur in patients with mitral insufficiency or pheochromocytoma Rebound hypertension may occur in pheochromocytoma patients Drug interaction overview Since phenothiazines and central nervous system depressants (opiates, analgesics, antihistamines, barbiturates) can potentiate each other, less than usual dosage of 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 and also 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; patients should be cautioned that their response to alcohol may be increased while they are being treated with perphenazine products; risk of suicide and danger of overdose may be increased in patients who use alcohol excessively due to its potentiation of drug’s effect Pregnancy Category: C Lactation: avoidPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Antipsychotic that blocks postsynaptic mesolimbic dopaminergic receptors in the brain; it has moderate anticholinergic effects, weak to moderate sedative effects, strong extrapyramidal effects, and strong antiemetic activity Pharmacokinetics Peak Plasma Time: 1-3 hr; 2-4 hr (metabolite) Half-Life: 9-12 hr (; 10-19 hr (metabolite) Concentration: 984 pg/mL; 509 pg/mL (metabolite) Metabolism: Hepatic P450 enzyme CYP2D6 Metabolites: 7-hydroxyperphenazine Enzymes inhibited: CYP2D6 Excretion: Urine and feces BRAND FORM. UNIT PRICE PILL IMAGE perphenazine oral- 2 mg tabletperphenazine oral- 4 mg tabletperphenazine oral- 16 mg tabletperphenazine oral- 8 mg tabletperphenazine oral- 16 mg tabletperphenazine oral- 8 mg tabletperphenazine oral- 4 mg tabletperphenazine oral- 2 mg tabletperphenazine oral- 4 mg tabletperphenazine oral- 2 mg tabletperphenazine oral- 4 mg tabletperphenazine oral- 8 mg tabletperphenazine oral- 2 mg tabletperphenazine oral- 16 mg tabletperphenazine oral- 2 mg tabletperphenazine oral- 8 mg tabletperphenazine oral- 4 mg tabletperphenazine oral- 8 mg tabletperphenazine oral- 4 mg tabletperphenazine oral- 16 mg tabletperphenazine oral- 8 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationperphenazine oral PERPHENAZINE - ORAL (per-FEN-a-zeen) COMMON BRAND NAME(S): Trilafon WARNING: There may be a slightly increased risk of serious, possibly fatal side effects (such as heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with dementia. This medication is not approved for the treatment of dementia-related behavior problems. Discuss the risks and benefits of this medication, as well as other effective and possibly safer treatments for dementia-related behavior problems, with the doctor. USES: This medication is used to treat certain mental/mood disorders (such as schizophrenia, manic phase of bipolar disorder, schizoaffective disorder). This medicine helps you to think more clearly, feel less nervous, and take part in everyday life. It can reduce aggressive behavior and the desire to hurt yourself/others. It may also help to decrease hallucinations (such as hearing/seeing things that are not there). Perphenazine is a psychiatric medication (antipsychotic-type) that works by helping to restore the balance of certain natural substances (such as dopamine) in the brain. HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually 1 to 3 times a day.The dosage is based on your medical condition and response to treatment. Your doctor may direct you to take a low dose at first, gradually increasing the dose to lower the chance of side effects (such as muscle spasms). Follow your doctor's directions carefully.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.Although you may notice some medication effects soon after starting, it may take as much as 4-6 weeks of regular use to see the full benefit. Do not stop taking this medication without consulting your doctor. Your condition may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.Tell your doctor if your condition does not improve or if it worsens. SIDE EFFECTS: Drowsiness, constipation, dry mouth, dizziness, lightheadedness, blurred vision, tiredness, or unexplained weight gain may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.Dizziness and lightheadedness can increase the risk of falling. Get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This drug may cause muscle/nervous system problems (extrapyramidal symptoms-EPS). Your doctor may prescribe another medication to decrease these side effects. Tell your doctor right away if you notice any of the following side effects: increased anxiety, drooling/trouble swallowing, restlessness/constant need to move, shaking (tremor), shuffling walk, stiff muscles.This medication may cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor right away if you develop any involuntary/repetitive muscle movements such as lip smacking/puckering, tongue thrusting, chewing, or finger/toe movements.In rare cases, perphenazine may increase your level of a certain chemical made by the body (prolactin). For females, this increase in prolactin may result in