Perphenazine

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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
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  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amobarbital
  • Amoxapine
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Anagrelide
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  • Anxiolytics; Sedatives; and Hypnotics
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  • Articaine; Epinephrine
  • Asenapine
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  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
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  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • 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
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  • Cannabidiol
  • Capsaicin; Metaxalone
  • 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
  • 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
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  • Clofazimine
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Crizotinib
  • Cyclobenzaprine
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  • Dapagliflozin
  • Dapagliflozin; Metformin
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  • Dasatinib
  • Degarelix
  • Delavirdine
  • 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
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  • Esketamine
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  • Ethanol
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  • 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
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  • Fentanyl
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  • Flibanserin
  • Fluconazole
  • Flucytosine
  • Fluocinolone; Hydroquinone; Tretinoin
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
  • Fluvoxamine
  • food
  • Foscarnet
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fosphenytoin
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  • Gabapentin
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  • Glimepiride; Pioglitazone
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  • 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
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  • 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
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  • Thiopental
  • Thioridazine
  • Thiothixene
  • Tiagabine
  • Timolol
  • tobacco
  • Tobramycin
  • Tolazamide
  • Tolbutamide
  • Tolterodine
  • Topiramate
  • Toremifene
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Tretinoin, ATRA
  • Triazolam
  • Triclabendazole
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimethobenzamide
  • Trimipramine
  • Triprolidine
  • Triptorelin
  • Trospium
  • Valproic Acid, Divalproex Sodium
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Verteporfin
  • Vigabatrin
  • Voriconazole
  • Vorinostat
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolpidem
  • Zonisamide

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