Perphenazine adverse effects

Despite enormous hype to the contrary, it soon became apparent that these newer medications were no less harmful than the older ones. Studies showing a lower rate of adverse effects simply used comparatively lower doses (Smith, 2001). Given that these drugs are neither safer nor more effective than older drugs like perphenazine (Trilafon see the subsequent sections), and given that they cost a great deal more (Rosenheck et ah, 2006), this was another triumph of pharmaceutical marketing. 

Note that perphenazine (Trilafon) is in the middle of the pack there was no statistical difference between it and the leader, olanzapine (Zy-prexa). But Zyprexa had the worst adverse effect profile (see subsequent sections). 

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... 

Fluoxetine. The combination of perphenazine and fluoxetine was found to be effective in the treatment of psychotic depression in 30 patients, and the adverse effects (which included dry mouth, blurred vision, constipation, tremor or rigidity, orthostasis and hypotension) were thought to be easier to tolerate than an antipsychotic with a tricyclic antidepressant. However, one woman developed marked extrapyramidal symptoms within 2 weeks of starting perphenazine 4 mg twice daily and fluoxetine 20 mg daily. ... 

On the whole significant interactions between the antipsychotics and SSRIs appear rare (although see thioridazine, below). The combination can be useful and so the isolated cases of extrapyramidal adverse effects should not prevent concurrent use. However, if extrapyramidal effects become troublesome bear this interaction in mind as a possible cause. The significance of the rise in haloperidol levels caused by fluoxetine and fluvoxamine is unclear, be aware that haloperidol adverse effects may be increased in some patients and consider reducing the haloperidol dose if problems occur. The rise in perphenazine levels caused by paroxetine seems to result in a greater number of more serious adverse effects and so consideration should be given to reducing the dose of perphenazine if paroxetine is started. Citalopram may be a suitable alternative as it does not appear to affect perphenazine levels. 

A woman was taking thiamazole for Graves disease, at times with various different antipsychotics including haloperidol, flupentixol, zuclopen-thixol and perphenazine for schizophrenia. Because of the severe extrapyramidal reactions and failure to control the schizophrenia, clozapine, increased over 5 days to 250 mg daily, was started instead. Within 5 days her white cell count had fallen to 2200/mm, which rose to 4000/mm, one month after both drugs were stopped. Later, after the thiamazole was stopped she was given the same dose of clozapine without these adverse effects. ... 

A 47-year-old woman with a history of schizophrenia developed fatal fulminant hepatitis after having taken 400 mg of powdered reishi daily for 2 months. She was also taking lithium, perphenazine, and trihexyphenidyl longterm. The woman had previously consumed an extract made from boiled reishi slices (dose not specified) for several years with no adverse effects. The reporting physicians indicated that the reaction could have been idiosyncratic (Wanmuang et al. 2007). 

Neuroleptics increase the toxicity of the sunlight to human skin, causing discolorations and other adverse dermal reactions. Researchers noted this phenomenon, called phototoxicity, and set out to study its effects on cells loaded with the neuroleptics fluphenazine, perphenazine, or thioridazine (Bastianon et al., 2005). They found that exposure of these cells to light caused abnormalities in both the plasma membrane and mitochondria. 

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