Antipsychotics perphenazine

Coley KC, Carter CS, DaPos SV, et al (1999). Effectiveness of antipsychotic therapy in a naturalistic setting a comparison between risperidone, perphenazine, and haloperidol./ Clin Psychiatry 60, 850-6. 

The answer is c. (Hardman, pp 414-4163) Unwanted pharmacologic side effects produced by phenothiazine antipsychotic drugs (e.g., perphenazine) include Parkinson-like syndrome, akathisia, dystonias, galactorrhea, amenorrhea, and infertility. These side effects are due to the ability of these agents to block dopamine receptors. The phenothiazines also block muscarinic and a-adrenergic receptors, which are responsible for other effects. 

Perphenazine 20-25 8.1-123 Second-generation antipsychotics (SGAs) CYP2D6 7-OH-perphenazine... 

Perphenazine (Trilafon). Perphenazine has a potency and side effect profile similar to other medium potency antipsychotics. 

From the chemical point of view antipsychotic drugs are subdivided into six chemical groups, as well as to the group of non-classifiable drugs. They are phenothiazines (chlorpromazine, promazine, triflupromazine, acetophenazine, fluphenazine, perphenazine, prochlorpherazine, trifluoperazine, mesoridazine, and thioridazine), thioxanthenes... 

The piperazines include fluphenazine, trifluoperazine, prochlorperazine, perazine and perphenazine. They are agents with a high antipsychotic potency with less pronounced anticholinergic effects. However their potential to produce extrapyramidal effects is more pronounced. 

One of the more methodologically rigorous studies on the utility of TCA/antipsychotic combinations in treating PMD was completed by Spiker et al. [1985). In this study, 54 patients who met criteria for depression with psychotic features on the Schedule for Affective Disorders and Schizophrenia [Endicott and Spitzer 1978) and by Research Diagnostic Criteria [Spitzer et al. 1985) were randomly selected to treatment with amitriptyline alone, perphenazine alone, or the combination of two drugs. After a 7-day placebo washout, patients were treated for 35 days with doses averaging approximately 50 mg/day of perphenazine and approximately 200 mg/day of ami-... 

To date, only one study has been completed with an antidepressant other than a TCA combined with an antipsychotic in the treatment of PMD. Rothschild and colleagues (1993) investigated the efficacy of fluoxetine and perphenazine in the treatment of PMD and found that approximately 73% of 30 patients who met DSM-III-R (American Psychiatric Association 1987) criteria for major depression with psychotic features had at least a 50% reduction on their Hamilton Rating Scale for Depression scores over 5 weeks. Furthermore, the combination of fluoxetine and perphenazine appeared to be better tolerated than the combination of TCAs with antipsychotics. Although there is no evidence that monotherapy with an antidepressant other than amoxapine is efficacious, the combination therapy with many antidepressants other than the TCAs may prove useful. 

Area of assessment Clinically sedative antipsychotics, Less sedative antipsychotics, e.g. chlorpromazine, clozapine, e.g. haloperidol, perphenazine, olanzapine pimozide, sulpiride ... 

Three subfamilies of phenothiazines, based primarily on the side chain of the molecule, were once the most widely used of the antipsychotic agents. Aliphatic derivatives (eg, chlorpromazine ) and piperidine derivatives (eg, thioridazine ) are the least potent. These drugs produce more sedation and weight gain. Piperazine derivatives are more potent (effective in lower doses) but not necessarily more efficacious. Perphenazine, a piperazine derivative, was the typical antipsychotic drug used in the CATIE study described in the following text. The piperazine derivatives are also more selective in their pharmacologic effects (Table 29-1). 

Recently, a large study in the USA (CATIE) reported that perphenazine was as effective as atypical antipsychotic drugs, with the modest exception of olanzapine, and concluded that typical antipsychotic drugs are the treatment of choice for schizophrenia based on their lower cost. However, this study did not adequately consider the risk of tardivedyskinesia or the treatment history of patients in the design of this study. 

Rosenheck, R., Leslie, D., Sindelar, J., Miller, E., Lin, H., Stroup, T., et al. (2006). Cost-effectiveness of second generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. American Journal of Psychiatry, 163, 2080-2089. 

PHENOTHIAZINES - CHLORPROMAZINE, PERPHENAZINE, PROCHLORPERAZINE, TRIFLUOPERAZINE Antipsychotics, below ... 

ANTIPSYCHOTICS-CHLORPROMAZINE, CLOZAPINE, HALOPERI-DOL, OLANZAPINE, PERPHENAZINE, RISPERIDONE, SERTINDOLE, THIORIDAZINE, ZUCLOPENTHIXOL H2 RECEPTOR BLOCKERS -CIMETIDINE t plasma concentrations of these antipsychotics, with risk of associated adverse effects Cimetidine is an inhibitor of CYP3A4 (sertindole, haloperidol, risperidone), CYP2D6 (chlorpromazine, risperidone, zudopenthixol, thioridazine, perphenazine) and CYP1A2 (clozapine, olanzapine, sertindole, haloperidol) Avoid concomitant use. Choose an alternative acid suppression, e.g. H2 antagonist... 

IMATINIB 1. ANTIARRHYTHMICS -flecainide, mexiletine, propafenone 2. ANTIDEPRESSANTS - fluoxetine, paroxetine, TCAs, trazodone, venlafaxine 3. ANTIPSYCHOTICS -clozapine, haloperidol, perphenazine, risperidone, thioridazine 4. BETA-BLOCKERS - metoprolol, propanolol, timolol 5. DONEPEZIL 6. METHAMPHETAMINE Imatinib may cause t plasma concentrations of these drugs, with a risk of toxic effects Inhibition of CYP2D6-mediated metabolism of these drugs Watch for early features of toxicity of these drugs... 

Patients with inadequate responses to atypical antipsychotics may benefit from a trial ot augmentation with a conventional antipsychotic such as perphenazine or trom switching to a conventional antipsychotic such as perphenazine... 

However, long-term polypharmacy with a combination ot a conventional antipsychotic such as perphenazine with an atypical antipsychotic may combine their side effects without clearly augmenting the efficacy of either... 

GG is a 42-year-old man who has been on perphenazine as maintenance therapy for schizophrenia diagnosed at age 25. His mother is concerned because she has noticed abnormal posturing and stiffness in the movements of the body and face over the past few months. Which agent would be most appropriate to reverse and prevent further dystonic symptoms due to GG s antipsychotic therapy ... 

Antipsychotics Seven patients developed delirium when given fluoxetine, paroxetine, or sertraline with benztropine in the presence of perphenazine... 

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