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amitriptyline/perphenazine (Rx)Brand and Other Names:

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

amitriptyline/perphenazine

tablet

  • 10mg/2mg
  • 25mg/2mg
  • 10mg/4mg
  • 25mg/4mg
  • 50mg/4mg
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Anxiety or Agitation with Depression

Indicated for (1) moderate-to-severe anxiety and/or agitation and depressed mood, (2) depression in whom anxiety and/or agitation are severe, and (3) depression and anxiety associated with chronic physical disease

Initial: 25 mg/2 mg or 25 mg/4 mg PO TID/QID, OR 50 mg/4 mg PO BID

Maintenance: 2 mg/25 mg or 4 mg/25 mg PO BID/QID, OR 50 mg/4 mg PO BID

10 mg/ 2 mg and 10 mg/4 mg can be used to increase flexibility in adjusting maintenance dosage to the lowest amount consistent with relief of symptoms

Do not exceed daily dose of 200 mg/16 mg

Schizophrenia with Depression

Indicated for patients with schizophrenic who have associated depressive symptoms

Initial: 50 mg/8 mg (ie, 2 tablets of 25 mg/4 mg) PO BID/TID; if needed a fourth dose may be given at bedtime

Maintenance: 2 mg/25 mg or 4 mg/25 mg PO BID/QID, OR 50 mg/4 mg PO BID

10 mg/ 2 mg and 10 mg/4 mg can be used to increase flexibility in adjusting maintenance dosage to the lowest amount consistent with relief of symptoms

Do not exceed daily dose of 200 mg/16 mg

Dosing Considerations

Depending on the condition being treated, therapeutic response may not be observed for several days up to 2-3 weeks, or longer

After a satisfactory response is noted, dosage should be reduced to the smallest amount necessary to obtain relief from the symptoms

Not recommended

Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria)

Consider alternatives; if must use, initiate with lower initial dose such as 1 tablet (amitriptyline 10 mg/perphenazine 4 mg) three/four times daily

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Interactions

Interaction Checker

amitriptyline/perphenazine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 

            Frequency Not Defined

            Sedation

            Fatigue

            Constipation

            Dry mouth

            Lethargy

            Weakness

            Anticholinergic effects

            Blurred vision

            Lens opacities

            Orthostatic hypotension

            Agitation

            Anxiety

            Headache

            Insomnia

            Nausea/vomiting

            Sweating

            Orthostatic hypotension

            ECG changes

            Tachycardia

            Confusion

            EPS

            Dizziness

            Paresthesia

            Rash 

            Increased LFTs

            Sexual dysfunction

            Tinnitus

            Seizure

            Agranulocytosis

            Thrombocytopenia

            Eosinophilia

            Leukopenia

            SIADH

            Antipsychotic side effects

            Poikilothermia

            Decreased gag reflex

            Weight gain

            Amenorrhea

            Post Marketing Reports

            Neuroleptic malignant syndrome

            Serotonin syndrome

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            Warnings

            Black Box Warnings

            Children & Antidepressants

            • In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (< 24 years of age) taking antidepressants for major depressive disorders and other psychiatric illnesses. This increase was not seen in patients >24 years of age. A slight decrease in suicidal thinking was seen in adults >65 years. Risks must be weighed in children and young adults against the benefits of taking antidepressants. Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies. This should be done during the initial 1-2 months of therapy and dosage adjustments. The patient’s family should communicate to the healthcare provider any abrupt changes in behavior. Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy. This drug is not approved for use in pediatric patients.

            Antipsychotics & Dementia

            • Patients with dementia-related psychosis that are treated with antipsychotic drugs are at an increased risk of death as shown in short-term controlled trials. The deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. This drug is not approved for the treatment of patients with dementia-related psychosis (See WARNINGS in package insert).

            Contraindications

            Tricyclic Antidepressant (amitriptyline): hypersensitivity, severe cardiovascular disorder, narrow angle glaucoma, within 14 days of MAOIs (risk of serotonin syndrome), any drugs or conditions that prolong QT interval, acute recovery post-MI

            Antipsychotic (perphenazine): hypersensitivity, CNS depression, neuroleptic malignant syndrome, poorly controlled seizure disorder, subcortical braine damage, coma, severe obtundation, high dose CNS depressants, blood dyscrasia, myelosuppression, liver damage

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: excreted in breast milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Amitriptyline: Antidepressant; neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; elicits anticholinergic effects  

            Perphenazine: Antipsychotic agent; elicits moderate anticholinergic effects, weak to moderate sedative effects, strong extrapyramidal effects, and strong antiemetic activity

            Pharmacokinetics

            Amitriptyline

            • Onset of action: 6 weeks
            • Half-life: 9-27 hr
            • Peak serum time: 4 hr
            • Metabolism: Hepatic (CYP2C19, CYP3A4)
            • Excretion: Urine (25-50%); bile (small amounts)

            Perphenazine

            • Half-life: 9-12 hr
            • Peak plasma time: 1-3 hr; 2-4 hr (metabolite)
            • Metabolism: Hepatic P450 enzyme (CYP2D6)
            • Excretion: Urine; feces
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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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