of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.amisulprideContraindicated (1)amisulpride, perphenazine. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.Monitor Closely (3)amitriptyline and amisulpride both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered. amisulpride and amitriptyline both increase sedation. Use Caution/Monitor. amisulpride and amitriptyline both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.Serious - Use Alternative (1)perphenazine and amisulpride both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.amitriptylineMonitor Closely (1)perphenazine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amitriptyline, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. amitriptyline, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.amobarbitalMonitor Closely (5)amobarbital and amitriptyline both increase sedation. Use Caution/Monitor. amobarbital will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. amobarbital will decrease the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. amobarbital and perphenazine both increase sedation. Use Caution/Monitor. amobarbital, amitriptyline. Other (see comment). Use Caution/Monitor. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.amoxapineMonitor Closely (4)amitriptyline and amoxapine both increase sedation. Use Caution/Monitor. perphenazine and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. perphenazine and amoxapine both increase sedation. Use Caution/Monitor. amitriptyline and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.Serious - Use Alternative (3)amitriptyline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug. perphenazine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug. amitriptyline and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.Minor (2)amoxapine, perphenazine. Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown. Additive anticholinergic effects. amoxapine, perphenazine. Either increases levels of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.anagrelideMonitor Closely (1)anagrelide and perphenazine both increase QTc interval. Use Caution/Monitor.anticholinergic/sedative combosMonitor Closely (4)anticholinergic/sedative combos and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. perphenazine increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. anticholinergic/sedative combos decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. anticholinergic/sedative combos decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.apomorphineMonitor Closely (3)apomorphine and amitriptyline both increase QTc interval. Use Caution/Monitor. perphenazine and apomorphine both increase sedation. Use Caution/Monitor. amitriptyline and apomorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)apomorphine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug. perphenazine decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.aprepitantMonitor Closely (1)aprepitant will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.arformoterolMonitor Closely (4)arformoterol and amitriptyline both increase QTc interval. Use Caution/Monitor. arformoterol and perphenazine both increase QTc interval. Use Caution/Monitor. perphenazine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. amitriptyline increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, arformoterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.aripiprazoleMonitor Closely (4)aripiprazole and perphenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. aripiprazole and amitriptyline both increase sedation. Use Caution/Monitor. aripiprazole and perphenazine both increase sedation. Use Caution/Monitor. aripiprazole and amitriptyline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)perphenazine will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.armodafinilMonitor Closely (3)perphenazine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. armodafinil will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. amitriptyline increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.arsenic trioxideSerious - Use Alternative (2)amitriptyline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug. perphenazine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherMonitor Closely (1)artemether and perphenazine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)artemether and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineMonitor Closely (1)artemether/lumefantrine will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)perphenazine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug. amitriptyline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)artemether/lumefantrine will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.asenapineMonitor Closely (4)asenapine and perphenazine both increase QTc interval. Use Caution/Monitor. asenapine and amitriptyline both increase sedation. Use Caution/Monitor. asenapine and amitriptyline both increase QTc interval. Use Caution/Monitor. asenapine and perphenazine both increase sedation. Use Caution/Monitor.Minor (1)asenapine will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.asenapine transdermalMonitor Closely (4)asenapine transdermal and amitriptyline both increase QTc interval. Use Caution/Monitor. asenapine transdermal and perphenazine both increase QTc interval. Use Caution/Monitor. asenapine transdermal and amitriptyline both increase sedation. Use Caution/Monitor. asenapine transdermal and perphenazine both increase sedation. Use Caution/Monitor.atazanavirMonitor Closely (2)atazanavir increases levels of amitriptyline by unspecified interaction mechanism. Use Caution/Monitor. atazanavir will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atomoxetineMonitor Closely (3)perphenazine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. atomoxetine and amitriptyline both increase QTc interval. Use Caution/Monitor. atomoxetine and perphenazine both increase QTc interval. Use Caution/Monitor.atorvastatinMonitor Closely (1)atorvastatin will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.atracuriumMonitor Closely (4)perphenazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. atracurium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. atracurium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor. atracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.atropineMonitor Closely (4)atropine decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. perphenazine increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. atropine decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor. atropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely.Minor (2)amitriptyline increases levels of atropine by unknown mechanism. Minor/Significance Unknown. perphenazine increases toxicity of atropine by unknown mechanism. Minor/Significance Unknown.atropine IV/IMMonitor Closely (4)atropine IV/IM decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. perphenazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. atropine IV/IM decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor. atropine IV/IM and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.Minor (2)perphenazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown. amitriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.avapritinibMonitor Closely (2)avapritinib and amitriptyline both increase sedation. Use Caution/Monitor. avapritinib and perphenazine both increase sedation. Use Caution/Monitor.azelastineMonitor Closely (2)azelastine and amitriptyline both increase sedation. Use Caution/Monitor. azelastine and perphenazine both increase sedation. Use Caution/Monitor.azithromycinMonitor Closely (2)perphenazine and azithromycin both increase QTc interval. Use Caution/Monitor. amitriptyline and azithromycin both increase QTc interval. Use Caution/Monitor.baclofenMonitor Closely (2)baclofen and perphenazine both increase sedation. Use Caution/Monitor. baclofen and amitriptyline both increase sedation. Use Caution/Monitor.bazedoxifene/conjugated estrogensMinor (1)bazedoxifene/conjugated estrogens, amitriptyline. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Estrogens and progestins may decr tricyclic antidepressant effects, while increasing TCA plasma concentration and adverse effects.bedaquilineMonitor Closely (2)amitriptyline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely perphenazine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybelladonna alkaloidsMonitor Closely (4)perphenazine increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. belladonna alkaloids and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. belladonna alkaloids decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. belladonna alkaloids decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.belladonna and opiumMonitor Closely (6)belladonna and opium and perphenazine both increase sedation. Use Caution/Monitor. belladonna and opium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. perphenazine increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. belladonna and opium and amitriptyline both increase sedation. Use Caution/Monitor. belladonna and opium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor. belladonna and opium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.benazeprilMinor (1)perphenazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown.benperidolMonitor Closely (3)benperidol and perphenazine both increase sedation. Use Caution/Monitor. benperidol and perphenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. benperidol and amitriptyline both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenMonitor Closely (3)benzhydrocodone/acetaminophen, amitriptyline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. benzhydrocodone/acetaminophen and perphenazine both increase sedation. Use Caution/Monitor. perphenazine will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone is prodrug of hydrocodone]) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.Serious - Use Alternative (2)benzhydrocodone/acetaminophen and amitriptyline both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate benzhydrocodone/acetaminophen, perphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. Increased risk of hypotension if ability to maintain blood pressure has been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (eg, phenothiazines or general anesthetics).benzphetamineMonitor Closely (3)perphenazine, benzphetamine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. perphenazine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. amitriptyline increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline, benzphetamine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.benztropineMonitor Closely (2)benztropine and amitriptyline both decrease cholinergic effects/transmission. Modify Therapy/Monitor Closely. Additive anticholinergic adverse effects may be seen with concurrent use. perphenazine increases effects of benztropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. .bethanecholMonitor Closely (1)bethanechol increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.bortezomibMinor (1)bortezomib will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.bosentanMinor (1)bosentan will decrease the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.brexanoloneMonitor Closely (1)brexanolone, perphenazine. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (2)brexpiprazole and amitriptyline both increase sedation. Use Caution/Monitor. brexpiprazole and perphenazine both increase sedation. Use Caution/Monitor.brimonidineMonitor Closely (2)brimonidine and perphenazine both increase sedation. Use Caution/Monitor. brimonidine and amitriptyline both increase sedation. Use Caution/Monitor.Minor (2)amitriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown. brimonidine increases effects of perphenazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.brivaracetamMonitor Closely (2)brivaracetam and amitriptyline both increase sedation. Use Caution/Monitor. brivaracetam and perphenazine both increase sedation. Use Caution/Monitor.bromocriptineSerious - Use Alternative (1)perphenazine decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate