Perphenazine

Perphenazine Brand Name– Trilafon

What is Perphenazine

Perphenazine is an oral antipsychotic agent. It is a piperazine phenothiazine and is structurally similar to trifluoperazine, prochlorperazine, and fluphenazine.

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study evaluated the effectiveness of selected atypical antipsychotics and perphenazine in schizophrenic patients.

The primary outcome measure was discontinuation of treatment for any cause, with secondary outcomes evaluating drug efficacy (determined via the PANSS and CGI scale), adverse event profiles, and reasons for drug discontinuation. For the primary outcome measure, 74% of patients discontinued study medication before 18 months.

The olanzapine group demonstrated a slightly longer time to discontinuation of treatment for any cause compared to the quetiapine or risperidone groups. The PANSS and CGI scores were similar in all groups.

However, discontinuation due to adverse events was greater in the olanzapine group, primarily due to weight gain and metabolic effects.

Perphenazine was associated with higher rates of discontinuation due to extrapyramidal symptoms.

In addition to the treatment of psychotic disorders and schizophrenia, perphenazine is also used for vomiting and intractable hiccups. Ten milligrams of perphenazine is equivalent to 100 mg of chlorpromazine, the prototype antipsychotic.

Perphenazine was approved by the FDA in 1957.

Indications

1. behavioral or psychological symptoms of dementia
2. nausea/vomiting
3. schizophrenia

For the treatment of schizophrenia

Side Effects

1. agranulocytosis
2. akathisia
3. amenorrhea
4. anaphylactoid reactions
5. angioedema
6. anorexia
7. aplastic anemia
8. appetite stimulation
9. asphyxia
10. atopic dermatitis
11. blurred vision
12. bradycardia
13. breast enlargement
14. bronchospasm
15. cardiac arrest
16. cerebral edema
17. cholestasis
18. confusion
19. constipation
20. contact dermatitis
21. corneal opacification
22. diarrhea
23. dizziness
24. drowsiness
25. dysphagia
26. dystonic reaction
27. ejaculation dysfunction
28. eosinophilia
29. erythema
30. exfoliative dermatitis
31. fever
32. galactorrhea
33. glycosuria
34. gynecomastia
35. headache
36. hemolytic anemia
37. hepatitis
38. hyperglycemia
39. hyperhidrosis
40. hyperprolactinemia
41. hypersalivation
42. hypertension
43. hyperthermia
44. hypoglycemia
45. hyponatremia
46. hypotension
47. hypothermia
48. ileus
49. impotence (erectile dysfunction)
50. infertility
51. insomnia
52. jaundice
53. laryngeal edema
54. lethargy
55. leukopenia
56. libido decrease
57. lupus-like symptoms
58. mastalgia
59. menstrual irregularity
60. miosis
61. myasthenia
62. mydriasis
63. nasal congestion
64. nausea
65. neuroleptic malignant syndrome
66. neutropenia
67. orthostatic hypotension
68. pallor
69. pancytopenia
70. parotitis
71. peripheral edema
72. photophobia
73. photosensitivity
74. polydipsia
75. polyuria
76. pruritus
77. pseudoparkinsonism
78. psychosis
79. purpura
80. QT prolongation
81. retinopathy
82. seborrhea
83. seizures
84. SIADH
85. sinus tachycardia
86. skin hyperpigmentation
87. stroke
88. tardive dyskinesia
89. thrombocytopenia
90. torsade de pointes
91. urinary incontinence
92. urinary retention
93. urticaria
94. visual impairment
95. vomiting
96. water intoxication
97. weight gain
98. xerostomia

Monitoring Parameters

• AIMS assessment
• CBC
• ophthalmologic exam
• serum prolactin
• thyroid function tests (TFTs)

Contraindications

• abrupt discontinuation
• accidental exposure
• agranulocytosis
• ambient temperature increase
• angina
• anticholinergic medications
• apheresis
• asthma
• AV block
• bone marrow suppression
• bradycardia
• breast cancer
• breast-feeding
• cardiomyopathy
• celiac disease
• chemotherapy
• children
• closed-angle glaucoma
• CNS depression
• coadministration with other CNS depressants
• coma
• dehydration
• dementia
• dental work
• driving or operating machinery
• dysphagia
• encephalopathy
• ethanol ingestion
• females
• fever
• geriatric
• GI obstruction
• head trauma
• heart failure
• hematological disease
• hepatic disease
• human immunodeficiency virus (HIV) infection
• hyperparathyroidism
• hyperprolactinemia
• hyperthermia
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypotension
• hypothermia
• hypothyroidism
• hypovolemia
• ileus
• infants
• infection
• infertility
• intracranial mass
• jaundice
• labor
• leukopenia
• long QT syndrome
• myocardial infarction
• neonates
• neurological disease
• neutropenia
• obstetric delivery
• ocular disease
• orthostatic hypotension
• Parkinson’s disease
• phenothiazine hypersensitivity
• pheochromocytoma
• pregnancy
• pregnancy testing
• prostatic hypertrophy
• pulmonary disease
• QT prolongation
• radiographic contrast administration
• renal failure
• Reye’s syndrome
• rheumatoid arthritis
• seizure disorder
• seizures
• sickle cell disease
• sleep deprivation
• strenuous exercise
• stroke
• suicidal ideation
• sulfite hypersensitivity
• sunlight (UV) exposure
• surgery
• systemic lupus erythematosus (SLE)
• tardive dyskinesia
• tobacco smoking
• urinary retention
• vomiting

Interactions

• Abarelix
• Abiraterone
• Acarbose
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
• Acetohexamide
• Alfentanil
• Alfuzosin
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alogliptin
• Alogliptin; Metformin
• Alogliptin; Pioglitazone
• Alosetron
• Alpha-glucosidase Inhibitors
• Alprazolam
• Amantadine
• Amifampridine
• Amikacin
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminoglycosides
• Aminolevulinic Acid
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Anagrelide
• Anticholinergics
• Anxiolytics; Sedatives; and Hypnotics
• Apomorphine
• Apraclonidine
• Aripiprazole
• Arsenic Trioxide
• Artemether; Lumefantrine
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Atomoxetine
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Azilsartan; Chlorthalidone
• Azithromycin
• Baclofen
• Barbiturates
• Bedaquiline
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
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• Bendroflumethiazide; Nadolol
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• Benzodiazepines
• Bepridil
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• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
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• Brexpiprazole
• Brimonidine; Timolol
• Bromocriptine
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
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• Butorphanol
• Cabergoline
• Canagliflozin
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• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Carteolol
• Carvedilol
• Celecoxib
• Cenobamate
• Central-acting adrenergic agents
• Ceritinib
• Cetrorelix
• Cevimeline
• Charcoal
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chloral Hydrate
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chloroquine
• Chlorothiazide
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorpropamide
• Chlorthalidone
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Cinacalcet
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Clemastine
• Clindamycin; Tretinoin
• Clobazam
• Clofazimine
• Clomipramine
• Clonazepam
• Clorazepate
• Clozapine
• Cobicistat
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Crizotinib
• Cyclobenzaprine
• Dacomitinib
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• Dapagliflozin; Metformin
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• Dasatinib
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• Desflurane
• Desipramine
• Desvenlafaxine
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dexmethylphenidate
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Diethylpropion
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dimenhydrinate
• Dipeptidyl Peptidase-4 Inhibitors
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disopyramide
• Dofetilide
• Dolasetron
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Dopamine
• Dorzolamide; Timolol
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Dronedarone
• Droperidol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Duloxetine
• Dutasteride; Tamsulosin
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Eliglustat
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Encainide
• Encorafenib
• Enflurane
• Entrectinib
• Ephedrine
• Epinephrine
• Eprosartan; Hydrochlorothiazide, HCTZ
• Eribulin
• Ertugliflozin
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Esketamine
• Estazolam
• Eszopiclone
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethosuximide
• Ethotoin
• Etomidate
• Ezogabine
• Fedratinib
• Felbamate
• Fenfluramine
• Fentanyl
• Fingolimod
• Flecainide
• Flibanserin
• Fluconazole
• Flucytosine
• Fluocinolone; Hydroquinone; Tretinoin
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluvoxamine
• food
• Foscarnet
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
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• Gabapentin
• Ganirelix
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• Gemtuzumab Ozogamicin
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• Glasdegib
• Glimepiride
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glipizide
• Glipizide; Metformin
• Glyburide
• Glyburide; Metformin
• Goserelin
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guanidine
• Halobetasol; Tazarotene
• Halofantrine
• Halogenated Anesthetics
• Haloperidol
• Halothane
• Histrelin
• Homatropine; Hydrocodone
• Hydantoins
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxychloroquine
• Hydroxyzine
• Ibuprofen; Oxycodone
• Ibutilide
• Iloperidone
• Imatinib
• Imipramine
• Incretin Mimetics
• Indapamide
• Inotuzumab Ozogamicin
• Insulins
• Iohexol
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• Isocarboxazid
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• Leuprolide
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• Levetiracetam
• Levodopa
• Levofloxacin
• Levomethadyl
• Levorphanol
• Linagliptin
• Linagliptin; Metformin
• Lithium
• Lofexidine
• Lomefloxacin
• Loperamide
• Loperamide; Simethicone
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• Lorazepam
• Loxapine
• Lumateperone
• Lurasidone
• Macimorelin
• Magnesium Salts
• Maprotiline
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• Mefloquine
• Meglitinides
• Melatonin
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Meprobamate
• Mequinol; Tretinoin
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• Metaxalone
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methadone
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• Methylphenidate
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• tobacco
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