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Perphenazine

Last reviewed on RxList: 6/12/2019
Perphenazine Side Effects Center

Last reviewed on RxList 6/12/2019

Perphenazine (perphenazine) Tablets are a piperazinyl phenothiazine prescribed for use in the treatment of schizophrenia, and for the control of severe nausea and vomiting in adults. Perphenazine is available in generic form. Common side effects of perphenazine include:

Serious side effects of perphenazine include:

Perphenazine may cause muscle or nervous system problems (extrapyramidal symptoms-EPS). Tell your doctor if you notice side effects of perphenazine including increased anxiety, drooling, trouble swallowing, constant need to move, shaking, shuffling walk, or stiff muscles.

Perphenazine is available in strengths of 2, 4, 8 and 16 mg. Dosage must be individualized and adjusted according to the severity of the condition and the response obtained. Perphenazine may interact with cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, medicine for seizures, depression or anxiety, atropine, lithium, gefitinib, imatinib, nilotinib, antibiotics, birth control pills or hormone replacement estrogens, blood pressure medication, blood thinners, certain asthma medications or bronchodilators, heart rhythm medications, HIV or AIDS medications, incontinence medications, insulin or diabetes medications you take by mouth, medication for nausea, vomiting, or motion sickness, medications to treat or prevent malaria, medications used for general anesthesia, medicines used to prevent organ transplant rejection, numbing medicines, stimulants or ADHD medications, ulcer or irritable bowel medications, or medicines to treat Parkinson's disease, restless leg syndrome, or pituitary gland tumor (prolactinoma). Tell your doctor all medications and supplements you use. Tell your doctor if you are pregnant or plan to become pregnant while using perphenazine. Taking antipsychotic medication such as perphenazine during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you become pregnant while taking perphenazine, do not stop taking it without your doctor's advice. Perphenazine can pass into breast milk and may harm a nursing baby. Consult your doctor before breastfeeding.

Our Perphenazine (perphenazine) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

SLIDESHOW

Schizophrenia: Symptoms, Types, Causes, Treatment See Slideshow
Perphenazine Consumer Information

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these signs of a serious movement disorder:

  • tremors or shaking in your arms or legs;
  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or
  • any new or unusual muscle movements you cannot control.

Also call your doctor at once if you have:

  • feeling restless, jittery, or agitated;
  • confusion, unusual thoughts or behavior;
  • seizure (convulsions);
  • extreme drowsiness or dizziness, feeling like you might pass out;
  • severe bloating or stomach cramps;
  • little or no urinating;
  • slow heart rate, weak pulse, weak or shallow breathing;
  • sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, red or swollen gums, trouble swallowing; or
  • severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats.

Older adults may be more likely to have side effects from this medication.

Common side effects may include:

  • mild dizziness or drowsiness;
  • blurred vision, headache;
  • sleep problems (insomnia), strange dreams;
  • loss of appetite, vomiting, diarrhea, constipation;
  • increased sweating or urination;
  • dry mouth or stuffy nose;
  • breast swelling or discharge; or
  • mild itching or skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Perphenazine (Perphenazine)

QUESTION

Schizophrenia is the most disabling mental illness. See Answer
Perphenazine Professional Information

SIDE EFFECTS

Not all of the following adverse reactions have been reported with this specific drug; however, pharmacological similarities among various phenothiazine derivatives require that each be considered. With the piperazine group (of which perphenazine (perphenazine) is an example), the extrapyramidal symptoms are more common, and others (e.g., sedative effects, jaundice, and blood dyscrasias) are less frequently seen.

CNS Effects

Extrapyramidal Reactions

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 the masticatory muscles, tight feeling in the throat, slurred speech, dysphagia, akathisia, dyskinesia, parkinsonism, and ataxia. Their incidence and severity usually increase with an increase in dosage, but there is considerable individual variation in the tendency to develop such symptoms. Extrapyramidal symptoms can usually be controlled by the concomitant use of effective antiparkinsonian drugs, such as benztropine mesylate, and/or by reduction in dosage. In some instances, however, these extrapyramidal reactions may persist after discontinuation of treatment with perphenazine (perphenazine) .

Persistent Tardive Dyskinesia

As with all antipsychotic agents, tardive dyskinesia may appear in some patients on long-term therapy or may appear after drug therapy has been discontinued. Although the risk appears to be greater in elderly patients on high-dose therapy, especially females, it may occur in either sex and in children. The symptoms are persistent and in some patients appear to be irreversible. The syndrome is characterized by rhythmical, involuntary movements of the tongue, face, mouth or jaw (e.g., protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements).

Sometimes these may be accompanied by involuntary movements of the extremities. There is no known effective treatment for tardive dyskinesia; antiparkinsonism agents usually do not alleviate the symptoms of this syndrome. It is suggested that all antipsychotic agents be discontinued if these symptoms appear. Should it be necessary to reinstitute treatment, or increase the dosage of the agent, or switch to a different antipsychotic agent, the syndrome may be masked. It has been reported that fine, vermicular movements of the tongue may be an early sign of the syndrome, and if the medication is stopped at that time the syndrome may not develop.

Other CNS Effects

include cerebral edema; abnormality of cerebrospinal fluid proteins; convulsive seizures, particularly in patients with EEG abnormalities or a history of such disorders; and headaches.

Neuroleptic malignant syndrome has been reported in patients treated with antipsychotic drugs (see WARNINGS).

Drowsiness may occur, particularly during the first or second week, after which it generally disappears. If troublesome, lower the dosage. Hypnotic effects appear to be minimal, especially in patients who are permitted to remain active.

Adverse behavioral effects include paradoxical exacerbation of psychotic symptoms, catatonic-like states, paranoid reactions, lethargy, paradoxical excitement, restlessness, hyperactivity, nocturnal confusion, bizarre dreams, and insomnia.

Hyperreflexia has been reported in the newborn when a phenothiazine was used during pregnancy.

Autonomic Effects

dry mouth or salivation, nausea, vomiting, diarrhea, anorexia, constipation, obstipation, fecal impaction, urinary retention, frequency or incontinence, bladder paralysis, polyuria, nasal congestion, pallor, myosis, mydriasis, blurred vision, glaucoma, perspiration, hypertension, hypotension, and change in pulse rate occasionally may occur. Significant autonomic effects have been infrequent in patients receiving less than 24 mg perphenazine (perphenazine) daily.

Adynamic ileus occasionally occurs with phenothiazine therapy, and if severe, can result in complications and death. It is of particular concern in psychiatric patients, who may fail to seek treatment of the condition.

Allergic Effects

urticaria, erythema, eczema, exfoliative dermatitis, pruritus, photosensitivity, asthma, fever, anaphylactoid reactions, laryngeal edema, and angioneurotic edema; contact dermatitis in nursing personnel administering the drug; and in extremely rare instances, individual idiosyncrasy or hypersensitivity to phenothiazines has resulted in cerebral edema, circulatory collapse, and death.

Endocrine Effects

lactation, galactorrhea, moderate breast enlargement in females and gynecomastia in males on large doses, disturbances in the menstrual cycle, amenorrhea, changes in libido, inhibition of ejaculation, syndrome of inappropriate ADH (antidiuretic hormone) secretion, false positive pregnancy tests, hyperglycemia, hypoglycemia, glycosuria.

Cardiovascular Effects

postural hypotension, tachycardia (especially with sudden marked increase in dosage), bradycardia, cardiac arrest, faintness, and dizziness. Occasionally the hypotensive effect may produce a shock-like condition. ECG changes, nonspecific (quinidine-like effect) usually reversible, have been observed in some patients receiving phenothiazine antipsychotics.

Sudden death has occasionally been reported in patients who have received phenothiazines. In some cases, the death was apparently due to cardiac arrest; in others, the cause appeared to be asphyxia due to failure of the cough reflex. In some patients, the cause could not be determined nor could it be established that the death was due to the phenothiazine.

Hematological Effects

agranulocytosis, eosinophilia, leukopenia, hemolytic anemia, thrombocytopenic purpura, and pancytopenia. Most cases of agranulocytosis have occurred between the fourth and tenth weeks of therapy. Patients should be watched closely, especially during that period, for the sudden appearance of sore throat or signs of infection. If white blood cell and differential cell counts show significant cellular depression, discontinue the drug and start appropriate therapy. However, a slightly lowered white count is not in itself an indication to discontinue the drug.

Other Effects

Special considerations in long-term therapy include pigmentation of the skin, occurring chiefly in the exposed areas; ocular changes consisting of deposition of fine particulate matter in the cornea and lens, progressing in more severe cases to star-shaped lenticular opacities; epithelial keratopathies; and pigmentary retinopathy. Also noted: peripheral edema, reversed epinephrine effect, increase in PBI not attributable to an increase in thyroxine, parotid swelling (rare), hyperpyrexia, systemic lupus erythematosus-like syndrome, increases in appetite and weight, polyphagia, photophobia, and muscle weakness.

Liver damage (biliary stasis) may occur. Jaundice may occur, usually between the second and fourth weeks of treatment, and is regarded as a hypersensitivity reaction. Incidence is low. The clinical picture resembles infectious hepatitis but with laboratory features of obstructive jaundice. It is usually reversible; however, chronic jaundice has been reported.

Read the entire FDA prescribing information for Perphenazine (Perphenazine)

Related Resources for Perphenazine

Read the Perphenazine User Reviews »

© Perphenazine Patient Information is supplied by Cerner Multum, Inc. and Perphenazine Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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