Amitriptyline and perphenazine

Name: Amitriptyline and perphenazine

What is amitriptyline and perphenazine?

Amitriptyline is a tricyclic antidepressant. Perphenazine is a phenothiazine (feen-oh-THYE-a-zeen). These medicines affect chemicals in the brain that may be unbalanced in people with depression or mental illness.

Amitriptyline and perphenazine is a combination medicine used to treat depression, anxiety, and agitation.

Amitriptyline and perphenazine may also be used for purposes not listed in this medication guide.

What other drugs will affect amitriptyline and perphenazine?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone.

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • cimetidine;

  • guanethidine;

  • heart rhythm medicine such as flecainide, propafenone, quinidine, and others;

  • other antidepressants or medicine to treat mental illness; or

  • seizure medication.

This list is not complete and other drugs may interact with amitriptyline and perphenazine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Consumer Information Use and Disclaimer

  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else's drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • This medicine comes with an extra patient fact sheet called a Medication Guide. Read it with care. Read it again each time amitriptyline and perphenazine is refilled. If you have any questions about this medicine, please talk with the doctor, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take amitriptyline and perphenazine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to amitriptyline and perphenazine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Review Date: October 4, 2017

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Amitriptyline hydrochloride 10 mg and perphenazine 2 mg

Amitriptyline hydrochloride 10 mg and perphenazine 4 mg

Amitriptyline hydrochloride 25 mg and perphenazine 2 mg

Amitriptyline hydrochloride 25 mg and perphenazine 4 mg

Amitriptyline hydrochloride 50 mg and perphenazine 4 mg

Pharmacologic Category

  • Antidepressant, Tricyclic (Tertiary Amine)
  • First Generation (Typical) Antipsychotic
  • Phenothiazine Derivative

Adverse Reactions

See individual agents.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience fatigue, anxiety, nausea, vomiting, lack of appetite, or dry mouth. Have patient report immediately to prescriber signs of depression (suicidal ideation, anxiety, emotional instability, or confusion), signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), behavioral changes, angina, signs of severe cerebrovascular disease (change in strength on one side is greater than the other, difficulty speaking or thinking, change in balance, or vision changes), severe dizziness, passing out, abnormal movements, twitching, tremors, rigidity, urinary retention, bruising, bleeding, loss of strength and energy, swelling of arm or leg, enlarged breasts, nipple discharge, sexual dysfunction, amenorrhea, signs of tardive dyskinesia (unable to control body movements; tongue, face, mouth, or jaw sticking out; mouth puckering; or puffing cheeks), or signs of neuroleptic malignant syndrome (fever, muscle cramps or stiffness, dizziness, severe headache, confusion, change in thinking, tachycardia, abnormal heartbeat, or sweating a lot) (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

For Healthcare Professionals

Applies to amitriptyline / perphenazine: oral tablet

General

The most commonly reported side effects included sedation, dry mouth, and hypertension.[Ref]

Nervous system

Frequency not reported: Neurological impairments, sedation

Amitriptyline:
Frequency not reported: Altered electroencephalogram patterns, ataxia, coma, disturbed concentration, dizziness, drowsiness, dysarthria, extrapyramidal symptoms, extremity paresthesia, headache, incoordination, numbness, peculiar taste, peripheral neuropathy, seizures, stroke, tingling, tremors

Perphenazine:
Frequency not reported: Acute dyskinesia, akathisia, altered cerebrospinal fluid proteins, ataxia, cerebral edema, dystonia, extrapyramidal symptoms, grand mal convulsions, headache, hyperreflexia, hypnotic effects, motor restlessness, pseudoparkinsonism, tardive dyskinesia[Ref]

Cardiovascular

Frequency not reported: Hypertension

Amitriptyline:
Frequency not reported: Arrhythmias, edema, heart block, hypertension, hypotension, myocardial infarction orthostatic hypotension, palpitation, tachycardia

Perphenazine:
Frequency not reported: ECG abnormalities/quinidine-like effect, hypertension, hypotension, occasional change in pulse rate, peripheral edema, reversed epinephrine effect, tachycardia[Ref]

Gastrointestinal

Frequency not reported: Dry mouth

Amitriptyline:
Frequency not reported: Black tongue, constipation, diarrhea, dry mouth, epigastric distress, nausea, paralytic ileus, parotid swelling, stomatitis, tongue edema, vomiting

Perphenazine:
Frequency not reported: Constipation, dry mouth, nausea, obstipation, salivation, vomiting[Ref]

Psychiatric

Amitriptyline:
Frequency not reported: Anxiety, confusional state, decreased libido, delusions, disorientation, dream disturbance, excitement, hallucinations, hypomania, increased libido, insomnia, irritability, mania, nightmares, restlessness, sleep disturbance

Perphenazine:
Frequency not reported: catatonic-like state production, mild insomnia, paradoxical excitement, reactivation of psychoses[Ref]

Genitourinary

Amitriptyline:
Frequency not reported: Breast enlargement, galactorrhea, testicular swelling, urinary frequency, urinary retention, urinary tract dilation

Perphenazine:
Frequency not reported: Ejaculation failure, galactorrhea, hyperglycemia, lactation, menstrual cycle disturbances, urinary frequency, urinary incontinence[Ref]

Hematologic

Amitriptyline:
Frequency not reported: Agranulocytosis, bone marrow depression, eosinophilia, leukopenia, purpura, thrombocytopenia

Perphenazine:
Frequency not reported: Agranulocytosis, blood dyscrasias, eosinophilia, leukopenia, pancytopenia, thrombocytopenic purpura

Dermatologic

Amitriptyline:
Frequency not reported: Alopecia, facial edema, increased perspiration, photosensitization, skin rash, urticaria

Perphenazine:
Frequency not reported: Eczema, erythema, exfoliative dermatitis, itching, photosensitivity, pigmentation, urticaria[Ref]

Ocular

Amitriptyline:
Frequency not reported: Accommodation disturbance, blurred vision, increased intraocular pressure, mydriasis

Perphenazine:
Frequency not reported: Blurred vision, corneal pigmentation, lens pigmentation, photophobia, pigmentary retinopathy[Ref]

Hepatic

Amitriptyline:
Frequency not reported: Altered liver function, hepatitis, jaundice

Perphenazine:
Frequency not reported: Biliary stasis, jaundice, liver damage

Endocrine

Amitriptyline:
Frequency not reported: Gynecomastia, syndrome of inappropriate antidiuretic hormone secretion

Perphenazine:
Frequency not reported: False positive pregnancy test, gynecomastia[Ref]

Metabolic

Amitriptyline:
Frequency not reported: Anorexia, blood sugar level elevation/lowering, weight gain/loss

Perphenazine:
Frequency not reported: Anorexia, polyphagia[Ref]

Other

Amitriptyline:
Frequency not reported: Fatigue, hyperpyrexia, malaise, tinnitus, weakness

Perphenazine:
Frequency not reported: Lassitude[Ref]

Respiratory

Perphenazine:
Frequency not reported: Asthma, laryngeal edema, nasal congestion[Ref]

Hypersensitivity

Perphenazine:
Frequency not reported: Anaphylactoid reactions, angioneurotic edema[Ref]

Musculoskeletal

Amitriptyline:
Frequency not reported: Muscle weakness[Ref]

Immunologic

Perphenazine:
Frequency not reported: Immunologic reactions[Ref]

Some side effects of amitriptyline / perphenazine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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