Perphenazine

(per-fen-uh-zeen)

Trade/Other Name(s): Trilafon

Why would this drug be used?

Perphenazine is an antipsychotic drug used for treatment of mental illness and other problems including psychosis, schizophrenia, and hiccups. It is also used to prevent nausea and vomiting caused by chemotherapy.

How does this drug work?

Perphenazine belongs to the general class of drugs called phenothiazines. It blocks certain messages to the brain. With nausea and vomiting, it prevents the "vomiting" message from being sent to the chemoreceptor trigger zone (CTZ).

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• If you have ever had seizures, have an abnormal EEG (brain waves) or are taking anti-seizure medicines. This drug may raise your risk of seizures.
• If you have prostate enlargement or glaucoma. This drug can worsen your symptoms.
• If you have asthma, sleep apnea, or emphysema (breathing problems). Perphenazine can worsen symptoms and make it harder to breathe.
• If you will be exposed to extreme heat while taking perphenazine. It can raise the risk of low blood pressure and other side effects.
• If you have an abnormal heart rhythm, heart block, heart failure, or any heart problem. Perphenazine can lower the blood pressure and cause falling or fainting.
• If you take tranquilizers (sedatives) such as diazepam (Valium), opioid pain relievers, muscle relaxers, sleeping pills or drink alcohol. Perphenazine may increase the sleepiness linked to these substances.
• If you have any medical conditions such as kidney disease, liver disease (including hepatitis), or diabetes. These conditions may require that your medicine dose, regimen, or timing be changed.
• If you are planning on having surgery in the near future. This drug can have harmful effects when used with anesthetics.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy.
• If you are breast-feeding. Small amounts of this drug pass into breast milk and may affect the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Medicines that make you urinate more (diuretics or "water pills") may cause your blood pressure to drop very low if taken with perphenazine.

Epinephrine may lower the blood pressure (rather than raise it) if it is taken with perphenazine. Your doctor can substitute another drug if epinephrine's effects are needed.

Certain antidepressants, such as fluoxetine (Prozac), paroxetine (Paxil), duloxetine (Cymbalta), and bupropion (Wellbutrin, Zyban) may cause perphenazine to build up in the body and cause worse side effects.

Substances that make you sleepy, such as alcohol, tranquilizers, opioid pain relievers, anesthetics, and sleeping pills will make you much sleepier and may cause serious harm when taken with perphenazine.

Check with your doctor, nurse, or pharmacist about whether any of the medicines, vitamins, herbs, and supplements you are taking can cause problems with perphenazine.

Interactions with foods

No serious interactions with food are known at this time, although alcohol should be avoided. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Perphenazine is taken as a pill or liquid by mouth 1 hour before, or by injection in a vein over 5 to 20 minutes before chemotherapy. Take the pill with food or a glass of milk to lessen stomach upset. It is also taken every 4 to 6 hours as needed to treat or prevent nausea and vomiting as directed by your doctor. Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Perphenazine may make you feel very sleepy. Do not drive or operate heavy machinery when you are drowsy.

Perphenazine can make you feel dizzy or faint, and increase your risk of falling. Be careful getting up, changing position, or walking. Start slowly and hold onto something or someone to hold you steady. Have another responsible adult with you until you know how the medicine will affect you and that you can take care of yourself.

Perphenazine may cause unplanned movements called extrapyramidal effects. These include restlessness, tremors, sticking out the tongue, muscle tightness, and other unplanned muscle movements or spasms. Let your doctor or nurse know right away if this happens. These often go away when you stop taking the drug. The movements can also usually be stopped by other medicines such as diphenhydramine (Benadryl). In some cases, your doctor may need to stop the perphenazine.

At higher doses over long periods, perphenazine can cause a movement problem called tardive dyskinesia. If you notice repeated instances of puffing out of cheeks, puckering of the mouth, grimacing, chewing movements, or sticking out the tongue, contact the doctor or nurse right away. Stopping the drug quickly may allow these problems to go away.

Call your doctor or nurse right away if you have restlessness, muscle stiffness, severe anxiety, slow jerky movements, tiredness, weakness, fever, confusion, trouble walking, irregular or fast heartbeat, or yellow eyes or skin.

Prochlorperazine may raise your risk of seizures if you have had them before.

This drug can cause problems during surgery, so your doctor may recommend lowering the dose or even stopping it before a scheduled operation

This drug can cause a rare problem called neuroleptic malignant syndrome, with symptoms like fever, tight muscles, tremors, sweating, constipation, and confusion. This syndrome can become life-threatening if not treated right away. If you have symptoms like these, call your doctor without delay.

Your urine may turn pink or reddish brown. This is not harmful and goes away when the drug is stopped.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• calmness, tranquility (sedation)
• sleepiness
• dry mouth
• constipation

Less common

• blurred vision
• restlessness
• unplanned muscle movements or spasms (extrapyramidal effects)*
• tremors
• increased appetite
• weight gain

Rare

• jaundice (yellowed skin or eyes)*
• rash
• hives
• increased risk of heat stroke or high body temperature
• increased sensitivity to sunlight with higher risk of sunburn
• low blood pressure when first sitting or standing up, with dizziness or fainting
• severe allergic reaction with itching, hives (skin welts), dizziness, trouble breathing or swallowing, swelling of the mouth, tongue, or face
• low white blood count with increased risk of infection
• tardive dyskinesia (involuntary movements that may become permanent)*

*See the "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984. (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.