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Perphenazine and Amitriptyline Brand Names- Etrafon | Etrafon-A | Triavil
What is Perphenazine and Amitriptyline
Perphenazine and amitriptyline is an oral combination product containing a phenothiazine antipsychotic (perphenazine) and a tricyclic antidepressant (amitriptyline).
Perphenazine and amitriptyline is indicated in patients with schizophrenia and associated depressive symptoms.
This combination is also used for combined depression with moderate to severe anxiety and/or agitation.
As with all antipsychotics and antidepressants, the product label includes a boxed warning regarding an increased mortality risk in elderly patients with dementia-related psychosis receiving an antipsychotic and regarding an increased risk of suicidality in children, adolescents, and young adults in the early phase of treatment with an antidepressant. Perphenazine; amitriptyline was approved by the FDA before 1982.
Clinically, the usefulness of this product is limited by the inability to titrate the dose of the individual components and the availability of newer antipsychotics and antidepressants with a relative increase in tolerability in many patients.
Indications
- agitation
- anxiety
- depression
- schizophrenia
For the treatment of depression in patients with moderate to severe anxiety and/or agitation
Side Effects
- abdominal pain
- agranulocytosis
- akathisia
- alopecia
- anaphylactoid reactions
- anorexia
- anxiety
- aplastic anemia
- ataxia
- blurred vision
- breast enlargement
- cholestasis
- coma
- confusion
- constipation
- corneal opacification
- cycloplegia
- depression
- diarrhea
- dizziness
- drowsiness
- dysarthria
- dystonic reaction
- edema
- EEG changes
- ejaculation dysfunction
- eosinophilia
- erythema
- exfoliative dermatitis
- fatigue
- galactorrhea
- gynecomastia
- hallucinations
- headache
- heart failure
- hemolytic anemia
- hyperprolactinemia
- hyperreflexia
- hypertension
- hyperthermia
- hypothermia
- ileus
- impotence (erectile dysfunction)
- increased urinary frequency
- insomnia
- jaundice
- laryngeal edema
- leukopenia
- libido decrease
- mania
- mastalgia
- menstrual irregularity
- mydriasis
- myocardial infarction
- nausea
- neuroleptic malignant syndrome
- neuroleptic malignant syndrome-like symptoms
- neutropenia
- ocular hypertension
- orthostatic hypotension
- palpitations
- pancytopenia
- paresthesias
- peripheral neuropathy
- photophobia
- photosensitivity
- polydipsia
- PR prolongation
- priapism
- pruritus
- pseudoparkinsonism
- purpura
- QT prolongation
- rash
- retinopathy
- seizures
- serotonin syndrome
- SIADH
- skin hyperpigmentation
- stroke
- suicidal ideation
- tardive dyskinesia
- testicular swelling
- thrombocytopenia
- tinnitus
- torsade de pointes
- tremor
- urinary incontinence
- urinary retention
- urticaria
- vasculitis
- ventricular tachycardia
- visual impairment
- vomiting
- water intoxication
- weakness
- weight gain
- withdrawal
- xerostomia
Monitoring Parameters
- AIMS assessment
- blood pressure
- CBC
- ECG
- heart rate
- LFTs
- ophthalmologic exam
- pregnancy testing
- serum amitriptyline concentrations
- serum prolactin
Contraindications
- abrupt discontinuation
- acute myocardial infarction
- agranulocytosis
- alcoholism
- ambient temperature increase
- angina
- anticholinergic medications
- asthma
- AV block
- bipolar disorder
- bone marrow suppression
- breast cancer
- breast-feeding
- bundle-branch block
- carbamazepine hypersensitivity
- cardiac arrhythmias
- cardiac disease
- chemotherapy
- children
- closed-angle glaucoma
- CNS depression
- coma
- constipation
- contact lenses
- dehydration
- dementia
- dental work
- diabetes mellitus
- driving or operating machinery
- dysphagia
- encephalopathy
- ethanol intoxication
- fever
- gastroesophageal reflux disease (GERD)
- geriatric
- GI disease
- GI obstruction
- head trauma
- hematological disease
- hepatic disease
- hyperprolactinemia
- hyperthermia
- hyperthyroidism
- hypothermia
- hypothyroidism
- hypovolemia
- ileus
- increased intraocular pressure
- infection
- infertility
- intracranial mass
- jaundice
- labor
- leukopenia
- mania
- MAOI therapy
- neonates
- neutropenia
- obstetric delivery
- ocular disease
- orthostatic hypotension
- Parkinson’s disease
- phenothiazine hypersensitivity
- pregnancy
- pregnancy testing
- prostatic hypertrophy
- pulmonary disease
- QT prolongation
- radiographic contrast administration
- renal failure
- Reye’s syndrome
- seizure disorder
- seizures
- strenuous exercise
- stroke
- suicidal ideation
- sunlight (UV) exposure
- surgery
- tardive dyskinesia
- tobacco smoking
- tricyclic antidepressant hypersensitivity
- urinary retention
- vomiting
Interactions
- Abarelix
- Abiraterone
- Acarbose
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetaminophen; Tramadol
- Acetazolamide
- Acetohexamide
- Acetylcholine Chloride
- Acrivastine; Pseudoephedrine
- Albendazole
- Alfentanil
- Alfuzosin
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Alogliptin
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alosetron
- Alpha-glucosidase Inhibitors
- Alprazolam
- Amantadine
- Ambenonium Chloride
- 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
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamines
- Anagrelide
- Anticholinergics
- Anxiolytics; Sedatives; and Hypnotics
- Apomorphine
- Apraclonidine
- Aprepitant, Fosaprepitant
- 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
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- Atomoxetine
- Atropine
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- Atropine; Difenoxin
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- Brimonidine; Timolol
- Brivaracetam
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- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Bupivacaine
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- Cannabidiol
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- Captopril; Hydrochlorothiazide, HCTZ
- 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
- Cetirizine
- Cetirizine; Pseudoephedrine
- Cetrorelix
- Cevimeline
- Charcoal
- Chlophedianol; Dexbrompheniramine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloral Hydrate
- Chlorcyclizine
- 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
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- Cholinergic agonists
- Cimetidine
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- Ciprofloxacin
- Cisapride
- Citalopram
- Clarithromycin
- Clemastine
- Clindamycin; Tretinoin
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- Clozapine
- Cobicistat
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- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
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- Crizotinib
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Dacomitinib
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- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Darifenacin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasatinib
- Degarelix
- Delavirdine
- Desflurane
- Desipramine
- Desloratadine; Pseudoephedrine
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmedetomidine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Dicyclomine
- Dienogest; Estradiol valerate
- Diethylpropion
- Diethylstilbestrol, DES
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Dipeptidyl Peptidase-4 Inhibitors
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Disulfiram
- Dofetilide
- Dolasetron
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Dopamine
- Dorzolamide; Timolol
- Doxepin
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Dronedarone
- Droperidol
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Duloxetine
- Dutasteride; Tamsulosin
- Edrophonium
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- 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
- Entacapone
- Entrectinib
- Ephedrine
- Epinephrine
- Eprosartan; Hydrochlorothiazide, HCTZ
- Eribulin
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Esketamine
- Eslicarbazepine
- Estazolam
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estrogens
- Estropipate
- 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
- Everolimus
- Ezogabine
- Fedratinib
- Felbamate
- Fenfluramine
- Fentanyl
- Fexofenadine; Pseudoephedrine
- Fingolimod
- Flavoxate
- Flecainide
- Flibanserin
- Fluconazole
- Flucytosine
- Flumazenil
- Fluocinolone; Hydroquinone; Tretinoin
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fluvoxamine
- food
- Fosamprenavir
- Foscarnet
- Fosinopril; Hydrochlorothiazide, HCTZ
- Fosphenytoin
- Fospropofol
- Fostemsavir
- Gabapentin
- Galantamine
- Ganirelix
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gentamicin
- Gilteritinib
- Givosiran
- Glasdegib
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Goserelin
- Granisetron
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Guanabenz
- Guanfacine
- Guanidine
- Guselkumab
- 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
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Ibutilide
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- Imipramine
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- Lidocaine
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- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methadone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methocarbamol
- Methohexital
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- Methscopolamine
- Methsuximide
- Methyclothiazide
- Methyldopa
- Methylene Blue
- Methylphenidate
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- Remifentanil
- Reserpine
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifamycins
- Rifapentine
- Rilpivirine
- Risperidone
- Ritonavir
- Rivastigmine
- Rolapitant
- Romidepsin
- Ropinirole
- Rosiglitazone
- Rotigotine
- Rufinamide
- Safinamide
- Saquinavir
- Saxagliptin
- Scopolamine
- Secobarbital
- Segesterone Acetate; Ethinyl Estradiol
- Selegiline
- Selpercatinib
- Serotonin-Receptor Agonists
- Sertraline
- Sevoflurane
- SGLT2 Inhibitors
- Short-acting beta-agonists
- Sibutramine
- Simeprevir
- Simvastatin; Sitagliptin
- Siponimod
- Sitagliptin
- Sodium Oxybate
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Solifenacin
- Sorafenib
- Sotalol
- Sparfloxacin
- St. John’s Wort, Hypericum perforatum
- Streptomycin
- Sufentanil
- Sulfonylureas
- Sunitinib
- Suvorexant
- Tacrine
- Tacrolimus
- Tamoxifen
- Tamsulosin
- Tapentadol
- Tazarotene
- Tedizolid
- Telaprevir
- Telavancin
- Telithromycin
- Telotristat Ethyl
- Temazepam
- Terbinafine
- Terfenadine
- Tetrabenazine
- Tetracaine
- Thalidomide
- Thiazide diuretics
- Thiazolidinediones
- Thiethylperazine
- Thiopental
- Thioridazine
- Thiothixene
- Thyroid hormones
- Tiagabine
- Timolol
- tobacco
- Tobramycin
- Tolazamide
- Tolbutamide
- Tolcapone
- Tolterodine
- Topiramate
- Toremifene
- Tramadol
- Tranylcypromine
- Trazodone
- Tretinoin, ATRA
- Triazolam
- Triclabendazole
- Tricyclic antidepressants
- Trifluoperazine
- Trihexyphenidyl
- Trimethobenzamide
- Trimipramine
- Triprolidine
- Triptorelin
- Trospium
- Valerian, Valeriana officinalis
- Valproic Acid, Divalproex Sodium
- Vandetanib
- Vardenafil
- Vasopressin, ADH
- Vemurafenib
- Venlafaxine
- Verteporfin
- Vigabatrin
- Vilazodone
- Voriconazole
- Vorinostat
- Vortioxetine
- Yohimbine
- Zaleplon
- Ziconotide
- Ziprasidone
- Zolpidem
- Zonisamide
