Presentation and Status in Health Basket
Film Coated Tablets
30 X 4 mg
Film Coated Tablets
20 x 8 mg
Adults: 4 mg perphenazine three times a day. Dose may have to be adjusted upwards or downwards according to patient response. Total daily dose should not exceed 24mg. Treatment should be started and dosage increased under close supervision. Treatment should be reviewed at intervals to avoid indiscriminate or unduly prolonged use. Elderly One quarter or one half of the recommended adult dosage. Perphenazine should be used with caution in the elderly. See prescribing information for full details. Children Perphenazine should not be given to children under the age of 14 years.
Method of administration: Oral Withdrawal symptoms seen on discontinuation of Perphenazine: Abrupt discontinuation should be avoided. See prescribing information for full details. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose, but at a more gradual rate.
Perphenazine should not be administered to patients with leucopenia, or in association with drugs liable to cause bone marrow depression, or to patients in comatose states. Perphenazine should not be administered to patients with a known hypersensitivity to perphenazine or any of the other excipients.
The possibility of suicide in depressed patient’s remains during treatment and until significant remission occurs. Perphenazine should not be used alone when depression is predominant. Perphenazine should be used with caution in patients with liver disease; severe respiratory disease; renal failure; epilepsy and conditions predisposing to epilepsy such as alcohol withdrawal or brain damage; Parkinson’s disease; patients who have shown sensitivity to other phenothiazines; personal or family history of narrow angle glaucoma; hypothyroidism, myasthenia gravis; phaeochromocytoma; or prostatic hypertrophy. Perphenazine should be used with caution in patient with cardiovascular disease, such as cardiac arrhythmias, congestive heart failure, and a personal or family history of QT prolongation. The concomitant use of other neuroleptics should be avoided because of possible potentiation of effects. Since temperature regulation may be impaired, care should be taken in extremely hot and in cold weather, especially in the elderly and frail because of risk of hypothermia. Acute withdrawal symptoms including nausea, vomiting, sweating and insomnia have been described after abrupt cessation of antipsychotic drugs. Recurrence of psychotic symptoms may also occur, and the emergence of involuntarymovement disorders (such as akathesia, dystonia and dyskinesia) has been reported. Therefore gradual withdrawal is advisable. Cases of venous thromboembolism (VTE) have been reported with antipsychotic drugs. Since patients treated with antipsychotics often present with acquired risk factors for VTE, all possible risk factors for VTE should be identified before and during treatment with perphenazine and preventivemeasures undertaken.
Increased Mortality in Elderly people with Dementia Data from two large observational studies showed that elderly people with dementia who are treated with antipsychotics are at a small increased risk of death compared with those who are not treated. There are insufficient data to give a firm estimate of the precise magnitude of the risk and the cause of the increased risk is not known. Perphenazine is not licensed for the treatment of dementia-related behavioural disturbances.
Opisthotonus, trismus, torticollis, retrocollis, aching and numbness of the limbs, motor restlessness, oculogyric crisis, hyperreflexia, dystonia, including protrusion, discoloration, aching and rounding of the tongue, tonic spasm of themasticatorymuscles, tight feeling in the throat, slurred speech, dysphagia, akathisia, dyskinesia, parkinsonism ataxia.
See prescribing information for full details.
Drug interactions affecting Perphenazine: Plasma concentrations of antipsychotics may increase when given with ritonavir or tricyclic antidepressants. Metabolism of perphenazine is inhibited when taken with paroxetine. Kaolin or antacids may decrease the absorption of perphenazine. Memantinemay reduce the effects of perphenazine
Interactions affecting other drugs: Perphenazine may enhance the hypotensive effect of other antihypertensivemedication. Risk of sedation and/or toxicity when perphenazine is administered with CNS depressants such as alcohol, antipsychotics, opioids, sedatives, and antihistamines. Tramadol when given with perphenazinemay increase the risk of convulsions. Risk of extrapyramidal reactions/anticholinergic effects when perphenazine is administered with Lithium, metoclopramide, fluoxetine. Perphenazine may antagonise the therapeutic effects of anticonvulsants. Perphenazine may antagonise the therapeutic effects of drugs used for Parkinson’s disease and other movement disorders. Perphenazine antagonises the hypoglycaemic effect of sulphonylureas. Phenothiazines may enhance the absorption of corticosteroids and digoxin. May affect action of anticoagulants and increase the bleeding time. Increased risk of toxicity when perphenazine is given with myelosupressive drugs. Use with concomitant QT prolonging drugs, drugs inhibiting the metabolism of perphenazine, and with drugs causing electrolyte imbalance is not recommended. If the benefit is considered to outweigh the risk in the individual patient, co-administration should be undertaken with caution and ECGmonitoring should be considered.
See prescribing information for full details.
Pregnancy and Lactation
Pregnancy: The safety of perphenazine in pregnancy has not yet been established. See prescribing information for full details.
Lactation: Phenothiazines may be excreted in breast milk; breast feeding should be suspended during treatment.
In patients who have overdosed, general supportive measures must be instituted. Gastric lavage should be considered up to 2 hours after ingestion. Emetics are unlikely to be effective because perphenazine is a potent anti-emetic. If hypotension is severe, fluid infusion may be needed. Central nervous systemdepression is treated conservatively. Temperature should be monitored to detect hypothermia, and this should be treated appropriately. If convulsions occur, these should be managed by standard means. Continuous monitoring of ECG should be instituted to detect any regularities of rhythm or QT interval for at least 48 hours.
Storage: Do not store above 25°C.
Lactose: contains lactose.