perphenazine (Rx)

Brand and Other Names:Trilafon
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablets

  • 2mg
  • 4mg
  • 8mg
  • 16mg

Intractable Hiccoughs

8-16 mg PO qDay divided q8-12hr

Maximum: 24 mg

Treatment of Nausea/Vomiting

8-16 mg PO qDay divided q6-12hr

Maximum: 24 mg

Schizophrenia

Hospitalized patients: 8-16mg PO q6-12hr

Hospitalized patients: Not to exceed 64 mg/day divided q6-12hr

Outpatients: 4-8mg PO q8hr; reduce as soon as possible to minimum effective dose

Hepatic Impairment

Dose adjustment not described in manufacturer's labeling

Renal Impairment

Dose adjustment not described in manufacturer's labeling

Dosage Forms & Strengths

tablets

  • 2mg
  • 4mg
  • 8mg
  • 16mg

Intractable Hiccoughs

<12 years

  • Not recommended by manufacturer

>12 years

  • 8-16 mg PO qDay divided q8-12hr Maximum: 24 mg

Schizophrenia

<12 years

  • Not recommended by manufacturer

>12 years

  • Hospitalized patients: 8-16mg PO q6-12hr
  • Hospitalized patients: Not to exceed 64 mg/day divided q6-12hr
  • Outpatients: 4-8mg PO q8hr; reduce as soon as possible to minimum effective dose

Initiate dosing at lower end of the range

Intractable Hiccoughs

8-16 mg PO qDay divided q8-12hr

Maximum: 24 mg

Treatment of Nausea/Vomiting

8-16 mg PO qDay divided q6-12hr

Maximum: 24 mg

Schizophrenia

Hospitalized patients: 8-16mg PO q6-12hr

Hospitalized patients: Not to exceed 64 mg/day divided q6-12hr

Outpatients: 4-8mg PO q8hr; reduce as soon as possible to minimum effective dose

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Interactions

Interaction Checker

and perphenazine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Akathisia (60%)

            Frequency Not Defined

            Confusion

            Decreased gag reflex

            EPS

            • Akathisia (60%)
            • Dystonia
            • Muscle stiffness
            • Neuroleptic malignant syndrome (infrequent but serious)
            • Parkinsonism
            • Tardive dyskinesia

            Common

            • Anticholinergic effects
            • Sedation
            • Weight gain
            • Oligomenorrhea/amenorrhea
            • Erectile dysfunction

            Less Common

            • Orthostatic hypotension (post-IM inj), tachycardia
            • Anxiety, agitation, cerebral edema, depression, dizziness, euphoria, headache, insomnia, restless, weakness
            • Anorexia, dyspepsia, constipation, ileus
            • Lens opacities (prolonged use)

            Uncommon

            • ECG changes
            • Photosensitivity
            • Pruritis
            • Galactorrhea
            • Ejaculatory disorder
            • Diarrhea
            • Blood dyscrasia

            Rare

            • Seizure
            • Priapism
            • Cholestatic jaundice
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            Warnings

            Black Box Warnings

            Patients with dementia-related psychosis who 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 (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

            This drug is not approved for the treatment of patients with dementia-related psychosis

            Contraindications

            Documented hypersensitivity to phenothiazines

            Coma, severe hypotension, severe CNS depression, concurrency with large amounts of CNS depressants, poorly controlled seizure disorder, subcortical brain damage, myelosuppression, liver damage, blood dyscrasias

            Severe cardiovascular disease

            Lactation

            Cautions

            Avoid using in children with suspected Reye's syndrome

            Glaucoma, prostatic hypertrophy, stenosing PUD, tardive dyskinesia, history of NMS, Parkinson's disease, hypocalcemia, renal/hepatic impairment, patients who have exhibited a severe reaction to insulin or ECT, history of seizures, asthma, respiratory tract infections, cardiovascular disease

            Hypotension may be particularly severe in patients with pheochromocytoma or mitral insufficiency

            Depresses hypothalamic thermoregulatory mechanism; exposure to extreme temperatures may cause hypo- or hyperthermia

            In case of severe hypotension, use norepinephrine or phenylepinephrine, do NOT use epinephrine or dopamine

            Antiemetic effect may obscure toxicity of chemotherapeutic drugs

            May need anticholinergic antiparkinsonian agent to counter EPS

            FDA Warning regarding off-label use for dementia in elderly

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: avoid

            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

            Antipsychotic that blocks postsynaptic mesolimbic dopaminergic receptors in the brain; it has moderate anticholinergic effects, weak to moderate sedative effects, strong extrapyramidal effects, and strong antiemetic activity

            Pharmacokinetics

            Peak Plasma Time: 1-3 hr; 2-4 hr (metabolite)

            Half-Life: 9-12 hr (; 10-19 hr (metabolite)

            Concentration: 984 pg/mL; 509 pg/mL (metabolite)

            Metabolism: Hepatic P450 enzyme CYP2D6

            Metabolites: 7-hydroxyperphenazine

            Enzymes inhibited: CYP2D6

            Excretion: Urine and feces

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            Formulary

            FormularyPatient Discounts

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            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.