PERPHENAZINEAND AMITRIPTYLINE (Systemic)
Some commonly used brand names are:
In the U.S.?
- Etrafon
- Etrafon-A
- Etrafon-Forte
- Triavil
In Canada?
- Elavil Plus
- Etrafon
- Etrafon-A
- Etrafon-D
- Etrafon-F
- PMS Levazine
- Triavil
Generic name product may be available in the U.S.
Category
- Antipsychotic-antidepressant
Description
Perphenazine and amitriptyline (per-FEN-a-zeen and a-mee-TRIP-ti-leen)combination is used to treat certain mental and emotional conditions.
This combination is available only with your doctor's prescription, inthe following dosage form:
Oral- Tablets (U.S. and Canada).
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For perphenazine andamitriptyline combination, the following should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to perphenazine (e.g., Trilafon) or other phenothiazines(such as acetophenazine [e.g., Tindal], chlorpromazine [e.g., Thorazine],fluphenazine [e.g., Prolixin], mesoridazine [e.g., Serentil], prochlorperazine[e.g., Compazine], promazine [e.g., Sparine], promethazine [e.g., Phenergan],thioridazine [e.g., Mellaril], trifluoperazine [e.g., Stelazine], triflupromazine[e.g., Vesprin], trimeprazine [e.g., Temaril]) or to amitriptyline (e.g.,Elavil) or other tricyclic antidepressants (such as amoxapine [e.g., Asendin],clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g.,Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline[e.g., Vivactil], trimipramine [e.g., Surmontil]). Also tell your health careprofessional if you are allergic to any other substances, such as foods, preservatives,or dyes.
Pregnancy?Studies have not been done in pregnant women. However,perphenazine and amitriptyline combination has not been shown to cause birthdefects in animal studies. Side effects such as jaundice and muscle tremorshave occurred in some newborn babies when their mothers received other phenothiazinesduring pregnancy.
Breast-feeding?Perphenazine and amitriptyline combination passesinto the breast milk and may cause drowsiness and other unwanted effects innursing babies.
Children?Certain side effects, such as muscle spasms of theface, neck, and back, tic-like or twitching movements, inability to move theeyes, twisting of the body, or weakness of the arms and legs, are more likelyto occur in children, who are usually more sensitive than adults to some ofthe side effects of perphenazine and amitriptyline combination.
The perphenazine and amitriptyline combination must be used with cautionin children with depression. Studies have shown occurrences of children thinkingabout suicide or attempting suicide in clinical trials for this medicine.More study is needed to be sure the perphenazine and amitriptyline combinationis safe and effective in children
Older adults?Confusion, vision problems, dizziness or fainting,drowsiness, dryness of mouth, constipation, problems in urinating, tremblingof the hands and fingers, and symptoms of tardive dyskinesia (such as uncontrolledmovements of the mouth, tongue, jaw, arms, and/or legs) are especially likelyto occur in elderly patients. Older patients are usually more sensitive thanyounger adults to the effects of perphenazine and amitriptyline combination.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases 2 different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingperphenazine and amitriptyline combination, it is especially important thatyour health care professional know if you are taking any of the following:
- Amphetamines or
- Appetite suppressants (diet pills) or
- Medicine for asthma or other breathing problems or
- Medicine for colds, sinus problems, or hay fever or other allergies(including nose drops and sprays)?Using these medicines with perphenazineand amitriptyline combination may increase the risk of serious effects onthe heart
- Antithyroid agents (medicine for overactive thyroid) or
- Cimetidine (e.g., Tagamet) or
- Methyldopa (e.g., Aldomet) or
- Metoclopramide (e.g., Reglan) or
- Metyrosine (e.g., Demser) or
- Pemoline (e.g., Cylert) or
- Pimozide (e.g., Orap) or
- Promethazine (e.g., Phenergan) or
- Rauwolfia alkaloids (alseroxylon [e.g., Rauwiloid], deserpidine [e.g.,Harmonyl], rauwolfia serpentina [e.g., Raudixin], reserpine [e.g., Serpasil])or
- Trimeprazine (e.g., Temaril)?Taking these medicines with perphenazineand amitriptyline combination may increase the risk of serious side effects
- Central nervous system (CNS) depressants (medicines that cause drowsiness)?Takingthese medicines with perphenazine and amitriptyline combination may increasethe CNS depressant effects
- Epinephrine (e.g., Adrenalin)?Severe low blood pressure (hypotension)and fast heartbeat may occur if epinephrine is used with perphenazine andamitriptyline combination
- Levodopa (e.g., Dopar)?Perphenazine may prevent levodopa fromworking properly in the treatment of Parkinson's disease
- Lithium (e.g., Lithane)?The amount of medicine you need totake may change
- Metrizamide?When this dye is used for myelograms during theuse of perphenazine and amitriptyline combination, there is an increased riskof seizures
- Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g.,Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline[e.g., Eldepryl], tranylcypromine [e.g., Parnate])?Taking amitriptylinewhile you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitorsmay cause sudden high body temperature, extremely high blood pressure, andsevere convulsions; however, sometimes certain of these medicines may be usedtogether under close supervision by your doctor
Other medical problems?The presence of other medicalproblems may affect the use of perphenazine and amitriptyline combination.Make sure you tell your doctor if you have any other medical problems, especially:
- Alcohol abuse?Certain side effects such as heat stroke maybe more likely to occur
- Asthma (history of) or other lung disease or
- Bipolar disorder (manic-depressive illness) or
- Blood disease or
- Breast cancer or
- Difficult urination or
- Enlarged prostate or
- Epilepsy or other seizure disorders or
- Glaucoma or
- Heart or blood vessel disease or
- Mental illness (severe) or
- Parkinson's disease or
- Stomach or intestinal problems?Perphenazine and amitriptylinecombination may make the condition worse
- Kidney disease or
- Liver disease?Higher blood levels of perphenazine and amitriptylinemay occur, increasing the chance of side effects
- Overactive thyroid?Perphenazine and amitriptyline combinationmay cause an increased chance of serious effects on the heart
- Reye's syndrome?There may be an increased chance of unwantedeffects on the liver
Proper Use of This Medicine
To lessenstomach upset, take this medicine immediately after meals or with food, unlessyour doctor has told you to take it on an empty stomach.
Do not take more of this medicine and do not take itmore often than your doctor ordered. This is particularly importantfor elderly patients, since they are more sensitive to the effects of thismedicine.
Sometimes perphenazine and amitriptyline combinationmust be taken for several weeks before its full effect is reached.
Dosing?The dose of perphenazine and amitriptylinecombination will be different for different patients. Follow your doctor's orders or the directions on the label. The followinginformation includes only the average doses of perphenazine and amitriptylinecombination. If your dose is different, do not changeit unless your doctor tells you to do so.
The number of tablets that you take depends on the strength of the medicine.Also, the number of doses you take each day, the timeallowed between doses, and the length of time you take the medicine dependon your special needs.
- For oral dosage form (tablets):
- For certain mental and emotional conditions:
- Adults?At first, 1 tablet taken three or four times a day.Your doctor may increase your dose if needed.
- Children?Use and dose must be determined by your doctor.
Missed dose?If you miss a dose of this medicine, take it assoon as possible. However, if it is within 2 hours of your next dose, skipthe missed dose and go back to your regular dosing schedule. Do not doubledoses.
Storage?To store this medicine:
- Keep out of the reach of children. Overdose of perphenazine and amitriptylinecombination is especially dangerous in young children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the medicine to break down.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
Yourdoctor should check your progress at regular visits to allow dose adjustmentsand help reduce side effects.
Do not stop taking this medicine without first checkingwith your doctor. Your doctor may want you to reduce gradually theamount you are taking before stopping completely. This is to prevent sideeffects and to prevent your condition from becoming worse.
Do not take this medicine within two hours of taking antacids or medicinefor diarrhea. Taking these products too close together may make this medicineless effective.
This medicine will add to the effects of alcohol and other CNS depressants(medicines that cause drowsiness). Some examples of CNS depressants are antihistaminesor medicine for hay fever, other allergies, or colds; sedatives, tranquilizers,or sleeping medicine; prescription pain medicine or narcotics; barbiturates;medicine for seizures; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the abovewhile you are using this medicine.
Before having any kind of surgery, dental treatment,or emergency treatment, tell the medical doctor or dentist in charge thatyou are taking this medicine. Taking perphenazine and amitriptylinecombination together with medicines that are used during surgery or dentalor emergency treatments may increase the CNS depressant effects.
The perphenazine and amitriptyline combination may cause some people tobe agitated, irritable or display other abnormal behaviors. It may also causesome people to have suicidal thoughts and tendencies or to become more depressed.If you or your caregiver notice any of these adverse effects, tell your doctorright away.
This medicine may cause some people to become drowsy or less alert thanthey are normally, especially during the first few weeks of treatment. Evenif this medicine is taken only at bedtime, it may cause some people to feeldrowsy or less alert on arising. Make sure you know howyou react to this medicine before you drive, use machines, or do anythingelse that could be dangerous if you are not alert.
Dizziness, lightheadedness, or fainting may occur,especially when you get up from a lying or sitting position. Getting up slowlymay help. If the problem continues or gets worse, check with your doctor.
This medicine may make you sweat less, causing your body temperature toincrease. Use extra care not to become overheated duringexercise or hot weather while you are taking this medicine, since overheatingmay result in heat stroke. Also, hot baths or saunas may make you feel dizzyor faint.
Perphenazine and amitriptyline combination may cause dryness of the mouth.For temporary relief, use sugarless gum or candy, melt bits of ice in yourmouth, or use a saliva substitute. However, if your mouth continues to feeldry for more than 2 weeks, check with your medical doctor or dentist. Continuingdryness of the mouth may increase the chance of dental disease, includingtooth decay, gum disease, and fungus infections.
Perphenazine may cause your skin to be more sensitive to sunlight thanit is normally. Exposure to sunlight, even for brief periods of time, maycause a skin rash, itching, redness or other discoloration of the skin, ora severe sunburn. When you begin taking this medicine:
- Stay out of direct sunlight, especially between the hours of 10:00a.m. and 3:00 p.m., if possible.
- Wear protective clothing, including a hat. Also, wear sunglasses.
- Apply a sun block product that has a skin protection factor (SPF)of at least 15. Some patients may require a product with a higher SPF number,especially if they have a fair complexion. If you have any questions aboutthis, check with your health care professional.
- Apply a sun block lipstick that has an SPF of at least 15 to protectyour lips.
- Do not use a sunlamp or tanning bed or booth.
If you have a severe reaction from the sun, check withyour doctor.
Side Effects of This Medicine
Along with its needed effects, perphenazine (included in this combinationmedicine) can sometimes cause serious side effects. Tardive dyskinesia (amovement disorder) may occur and may not go away after you stop using themedicine. Signs of tardive dyskinesia include fine, worm-like movements ofthe tongue, or other uncontrolled movements of the mouth, tongue, cheeks,jaw, or arms and legs. Other serious but rare side effects may also occur.These include severe muscle stiffness, fever, unusual tiredness or weakness,fast heartbeat, difficult breathing, increased sweating, loss of bladder control,and seizures (neuroleptic malignant syndrome). You andyour doctor should discuss the good this medicine will do as well as the risksof taking it.
Stop taking this medicineand get emergency help immediately if any of the following side effectsoccur:
Also, checkwith your doctor as soon as possible if any of the following side effectsoccur:
More common
Blurred vision or any change in vision; difficulty in speaking or swallowing; fainting; inability to move eyes; lip smackingor puckering; loss of balance control; mask-like face; muscle spasms, especiallyof face, neck, and back; nervousness, restlessness,or need to keep moving; puffing of cheeks; rapid or fine, worm-like movements of tongue; shuffling walk; stiffness of arms and legs; trembling and shaking of fingers and hands; tic-like or twitching movements; twisting movementsof body; uncontrolled chewing movements; uncontrolled movements of arms or legs; weakness of arms and legs
Less common
Confusion; constipation; difficult urination; eye pain; hallucinations (seeing, hearing, or feeling things that are notthere); increased skin sensitivity to sun; shakiness; slow pulse or irregular heartbeat
Rare
Abdominal or stomach pain; aching musclesor joints; back or leg pain; fever and chills; hair loss; hot, dry skin or lack of sweating; irritability; loss of appetite; muscle weakness ortwitching; nausea, vomiting, or diarrhea; nosebleeds; prolonged, painful, inappropriatepenile erection; ringing, buzzing, or other unexplainednoises in ears; skin discoloration; skin rash and itching; sore throat andfever; swelling of face and tongue; swelling of testicles; unusual bleedingor bruising; yellow eyes or skin
Symptoms of overdose
Agitation; confusion; convulsions (seizures); drowsiness (severe); enlarged pupils; fast, slow, or irregularheartbeat; fever; hallucinations(seeing, hearing, or feeling things that are not there); shortness of breath or troubled breathing; unusualtiredness or weakness (severe); vomiting (severe)
Other side effects may occur that usually do not need medicalattention. These side effects may go away during treatment as your body adjuststo the medicine. However, check with your doctor if any of the following sideeffects continue or are bothersome:
After you stop using this medicine, your bodymay need time to adjust. The length of time this takes depends on the amountof medicine you are using and how long you used it. During this time, checkwith your doctor if you notice any of the following symptoms:
Dizziness; nausea or vomiting; stomach pain; trembling of fingers andhands; symptoms of tardive dyskinesia, includinglip smacking or puckering, puffing of cheeks, rapid or fine, worm-like movementsof tongue, uncontrolled chewing movements, or uncontrolled movements of armsor legs
Otherside effects may occur if the medicine is stopped suddenly or stopped afterlong-term treatment. Check with your doctor if you notice any of the followingsymptoms:
Diarrhea; headache; irritability; restlessness; trouble in sleeping, with vivid dreams; unusual excitement
Other side effects not listed above mayalso occur in some patients. If you notice any other effects, check with yourdoctor.
Revised: 01/25/2005
