Generic Name: Perphenazine Brand Name(s): Generics only. No brands available.

Uses

What is Perphenazine used for?

Perphenazine is used to treat certain mental/mood disorders (e.g., schizophrenia, manic phase of bipolar disorder, schizoaffective disorder). This medicine helps you to think more clearly, feel less nervous, and take part in everyday life. It can reduce aggressive behavior and the desire to hurt yourself/others. It may also help to decrease hallucinations (e.g., hearing/seeing things that are not there). Perphenazine is a psychiatric medication (antipsychotic-type) that works by helping to restore the balance of certain natural substances (e.g., dopamine) in the brain.

How should I take Perphenazine?

Take this medication by mouth, usually 1-3 times a day with or without food or as directed by your doctor.

Dosage is based on your medical condition and response to therapy. Your doctor may direct you to take a low dose at first, gradually increasing the dose to lower the chance of side effects such as muscle spasms. Follow your doctor’s directions carefully.

When you begin treatment, frequent visits to your doctor may be needed to find the best dose for you. Keep all medical/lab appointments.

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

Although you may notice some medication effects soon after starting, it may take as much as 4-6 weeks of regular use to see the full benefit. Do not stop taking this medication without consulting your doctor. Your condition may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.

Tell your doctor if your condition does not improve or if it worsens.

How do I store Perphenazine?

Perphenazine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Perphenazine in the bathroom or the freezer. There may be different brands of Perphenazine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Perphenazine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Perphenazine?

Before taking perphenazine, tell your doctor or pharmacist if you are allergic to it, or to other phenothiazines (e.g., chlorpromazine, fluphenazine), or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: decreased bone marrow function, serious head injury, liver problems, nervous system problem (such as coma, drug/alcohol overdose, shock), Parkinson’s disease, history of alcohol/substance abuse, low blood pressure, breathing problems (such as asthma, emphysema), breast cancer, fast/irregular heartbeat, heart valve problems, a certain adrenal gland tumor (pheochromocytoma), restless legs syndrome, seizure disorder, a certain severe reaction to other medications (neuroleptic malignant syndrome), difficulty urinating (e.g., due to prostate problems).

Perphenazine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using perphenazine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics “water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using perphenazine safely.

This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana.

This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.

Before having surgery, tell your doctor or dentist that you are taking this medication.

Caution is advised during hot weather because perphenazine can reduce sweating, increasing your risk for a severe reaction to too much heat (heatstroke). Drink plenty of fluids. Avoid strenuous exercise in hot weather. If you become overheated, promptly seek cooler shelter and/or stop exercising. Seek immediate medical attention if your body temperature is above normal or if you have mental/mood changes, headache, or dizziness.

Older adults may be more sensitive to the side effects of this drug, especially dizziness, lightheadedness, drowsiness, extrapyramidal symptoms, tardive dyskinesia, and QT prolongation (see above). Drowsiness, dizziness, and lightheadedness can increase the risk of falling.

During pregnancy, this medication should be used only when clearly needed. Babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop symptoms including muscle stiffness or shakiness, drowsiness, feeding/breathing difficulties, or constant crying. If you notice any of these symptoms in your newborn especially during their first month, tell the doctor right away.

Since untreated mental/mood problems (such as schizophrenia, bipolar disorder, schizoaffective disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.

Perphenazine passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Perphenazine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Perphenazine. Perphenazine is pregnancy risk category N according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Perphenazine?

Drowsiness, constipation, dry mouth, dizziness, lightheadedness, blurred vision, tiredness, or unexplained weight gain may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Dizziness and lightheadedness can increase the risk of falling. Get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Some people using this medication do not have serious side effects.

This drug may cause muscle/nervous system problems (extrapyramidal symptoms-EPS). Your doctor may prescribe another medication to decrease these side effects. Therefore, tell your doctor right away if you notice any of the following side effects: increased anxiety, drooling/trouble swallowing, restlessness/constant need to move, shaking (tremor), shuffling walk, stiff muscles.

Tell your doctor right away if any of these unlikely but serious side effects occur: difficulty urinating.

This medication may cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor right away if you develop any involuntary/repetitive muscle movements such as lip smacking/puckering, tongue thrusting, chewing, or finger/toe movements.

In rare cases, perphenazine may increase your level of a certain chemical made by the body (prolactin). For females, this increase in prolactin may result in unwanted breast milk, missed/stopped periods, or difficulty becoming pregnant. For males, it may result in decreased sexual ability, inability to produce sperm, or enlarged breasts. If you develop any of these symptoms, tell your doctor right away.

Tell your doctor right away if any of these rare but very serious side effects occur: easy bruising/bleeding, slow heartbeat, signs of infection (e.g., sore throat), severe muscle spasm/cramping (e.g., twisting neck, arching back, eyes rolling up), persistent nausea, seizures, stomach/abdominal pain, yellowing eyes/skin.

Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting.

This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, signs of kidney problems (such as change in the amount of urine).

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Perphenazine?

Some products that may interact with this drug are: certain drugs used for Parkinson’s disease (e.g., bromocriptine, levodopa, pergolide), certain anticholinergic medications (e.g., dicyclomine, scopolamine), drugs affecting liver enzymes that remove perphenazine from your body (e.g., amiodarone, duloxetine, fluoxetine, paroxetine, ritonavir).

Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana, drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Perphenazine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Perphenazine?

Perphenazine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Perphenazine?

Perphenazine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Perphenazine.

What is the dose of Perphenazine for an adult?

Usual Adult Dose for Psychosis

Moderately disturbed, nonhospitalized patients:

-Recommended dose: 4 to 8 mg orally 3 times a day, with a dose reduction to the minimum effective dose as soon as possible

-Maximum dose: 24 mg/day

Hospitalized patients:

-Recommended dose: 8 to 16 mg orally 2 to 4 times a day

-Maximum dose: 64 mg/day

Comment:

-Nonhospitalized patients should be limited to a daily dose of 24 mg; maximum doses of 64 mg should be used in hospitalized patients.

Use: Treatment of schizophrenia

Usual Adult Dose for Nausea/Vomiting

Recommended dose: 8 to 16 mg orally, in divided doses

Maximum dose: 24 mg/day, in divided doses

Comment:

-The dose should be reduced as early as possible.

Use: Severe nausea and vomiting

Renal Dose Adjustments

Use with caution.

Liver Dose Adjustments

Patients with liver damage: Contraindicated

Dose Adjustments

Abnormalities in hepatic tests, BUN, and/or signs/symptoms of blood dyscrasias:

-Discontinue treatment and monitor appropriately.

Elderly patients: Lower initial doses are recommended. Clinical benefit may require lower doses for longer periods of time.

Other Comments

Administration advice:

-For some patients, this drug may be given before bed.

Storage requirements:

-See manufacturer product information.

General:

-All patients on prolonged treatment should be reassessed regularly.

-Patients receiving long-term treatment may have a higher risk of developing liver damage, corneal/lenticular deposits, and/or irreversible dyskinesia.

-Treatment has not been effective for the management of behavioral complications in patients with mental impairments.

Monitoring:

-ECG monitoring for patients at risk of QT prolongation

-Periodic WBC with differential tests, especially in patients with signs/symptoms of infection/sore throat, at increased risk of blood dyscrasias, and/or with a history of low WBCs or drug-induced neutropenia/leukopenia

-Periodic liver function tests

-Blood pressure, especially in patients with impaired cardiovascular systems

-Eye examinations, especially in patients on prolonged treatment

-Heart rate, especially in patients with arrhythmias and/or taking QT prolonging drugs concurrently

-Periodic renal function tests, especially in patients on prolonged treatment

Patient advice:

-Patients should be warned to avoid abrupt discontinuation of this drug.

-Patients should be instructed to immediately report any signs/symptoms of neutropenia/leukopenia, neuroleptic malignant syndrome, or tardive dyskinesia.

-Inform patients that this drug may cause or impair mental/physical abilities, and they should avoid driving or operating machinery until the full effects of the drug are seen.

-Patients should be advised to speak to a healthcare provider if they are pregnant, intend to become pregnant, or are breastfeeding.

What is the dose of Perphenazine for a child?

Usual Pediatric Dose for Psychosis

12 years and older:

Moderately disturbed, nonhospitalized patients:

-Recommended dose: 4 to 8 mg orally 3 times a day, with a dose reduction to the minimum effective dose as soon as possible

-Maximum dose: 24 mg/day

Hospitalized patients:

-Recommended dose: 8 to 16 mg orally 2 to 4 times a day

-Maximum dose: 64 mg/day

Comments:

-Nonhospitalized patients should be limited to a daily dose of 24 mg; maximum doses of 64 mg should be used in hospitalized patients.

Use: Treatment of schizophrenia

Usual Pediatric Dose for Nausea/Vomiting

12 years and older:

-Recommended dose: 8 to 16 mg orally, in divided doses

-Maximum dose: 24 mg/day, in divided doses

Comment:

-The dose should be reduced as early as possible.

Use: Severe nausea and vomiting

Precautions

Safety and efficacy have not been established in patients younger than 12 years.

How is Perphenazine available?

Perphenazine is available in the following dosage forms and strengths:

  • Injectable solution,
  • Oral tablet,
  • Oral concentrate,
  • Compounding powder.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Perphenazine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 11, 2018 | Last Modified: April 11, 2018

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