Perphenazine

Perphenazine is a prescription medicine used to treat the symptoms of intractable hiccoughs, schizophrenia, nausea, and vomiting.

• Perphenazine is available under the following different brand names: Etrafon, Trilafon (discontinued)

Adult and pediatric dosage

Tablets

• 2mg
• 4mg
• 8mg
• 16mg

Treatment of Nausea/Vomiting

Adult and geriatric dosage

• 8-16 mg orally once daily divided every 6-12 hours
• Maximum: 24 mg

Schizophrenia

Adult and geriatric dosage

• Hospitalized patients: 8-16mg orally every 6-12 hours
• Hospitalized patients: Not to exceed 64 mg/day divided every 6-12 hours
• Outpatients: 4-8mg orally every 8 hours; reduce as soon as possible to minimum effective dose

Pediatric dosage

• Children below 12 years: Not recommended by the manufacturer
• Children above 12 years:
  • Hospitalized patients: 8-16mg orally every 6-12 hours
  • Hospitalized patients: Not to exceed 64 mg/day divided every 6-12 hours
  • Outpatients: 4-8mg orally every 8 hours; reduce as soon as possible to minimum effective dose

Intractable Hiccoughs

Geriatric dosage

• 8-16 mg orally once daily divided  every 8-12 hours
• Maximum: 24 mg

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Perphenazine include:

• mild dizziness,
• blurred vision,
• headache,
• drowsiness,
• sleep problems (insomnia),
• strange dreams,
• loss of appetite,
• vomiting,
• diarrhea,
• constipation,
• increased sweating,
• increased urination,
• dry mouth,
• stuffy nose,
• breast swelling or discharge,
• mild itching, and
• skin rash.

Serious side effects of Perphenazine include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• tremors or shaking in arms or legs,
• uncontrolled muscle movements in the face (chewing, lip-smacking, frowning, tongue movement, blinking or eye movement),
• new or unusual muscle movements that cannot control,
• restless,
• jitteriness,
• agitation,
• confusion,
• unusual thoughts or behavior,
• seizure,
• extreme drowsiness,
• dizziness,
• lightheadedness,
• severe bloating,
• stomach cramps,
• little or no urinating,
• slow heart rate,
• weak pulse,
• weak or shallow breathing,
• sudden weakness,
• ill-feeling,
• fever,
• chills,
• sore throat,
• mouth sores,
• red or swollen gums,
• trouble swallowing,
• very stiffness (rigid) muscles,
• high fever,
• sweating, and
• fast or uneven heartbeats.

Rare side effects of Perphenazine include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Perphenazine has severe interactions with the following drugs:
  • amisulpride
  • disopyramide
  • ibutilide
  • indapamide
  • metrizamide
  • pentamidine
  • pimozide
  • procainamide
  • quinidine
  • sotalol
• Perphenazine has serious interactions with at least 93 other drugs.
• Perphenazine has moderate interactions with at least 339 other drugs.
• Perphenazine has minor interactions with at least 78 other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• 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

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Perphenazine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Perphenazine?”

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 the convulsive threshold in susceptible individuals; they should be used with caution in alcohol withdrawal and patients with convulsive disorders; if the 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; the 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 the 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 the 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 a 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 the first few months of therapy discontinued at the first sign of a decline in WBC in absence of other causative factors
  • Blood counts should be checked periodically; the appearance of signs of blood dyscrasias requires discontinuance of drug and institution of appropriate therapy
• Tardive dyskinesia
  • The risk of developing the syndrome and the 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 a manner that is most likely to minimize the occurrence of tardive dyskinesia
  • Chronic antipsychotic treatment should generally be reserved for patients who suffer from a 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 the 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; the 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 the 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 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 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 and Lactation

• Use with caution if benefits outweigh risks during pregnancy
• Lactation
  • Avoid drug use during breastfeeding