Amitriptyline-perphenazine

Amitriptyline (Elavil), chlordiazepoxide-amitriptyline (Limbitrol), and perphenazine-amitriptyline (Triavil) Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients. High... 

PERPHENAZINE/AMITRIPTYLINE (Etrafon 2-10 tablets 2 mg perphenazine/10 mg amitriptyline, Etrafon tablets 2 mg perphenazine S mg amitriptyline, Etrafon-A tablets 4 mg perphenazine/... 

Perphenazine/amitriptyline are indicated in the treatment of moderate to severe anxiety or agitation and depressed mood moderate to severe depression and anxiety associated with chronic physical disease treatment of patients in whom depression and anxiety cannot be clearly differentiated and treatment of schizophrenia with associated depression. 

Thiothixene, useful in treatment of schizophrenia, was also found useful in treating neurotic patients In another study, it was found as effective as the perphenazine-amitriptyline combination in treating psychoneurotic depressive symptoms4 ... 

Eerguson, G. K. Quantitative HPLG Analysis of a Psychotherapeutic Medication Simultaneous Determination of Amitriptyline Hydrochloride and Perphenazine, /. Chem. Educ. 1998, 75, 1615-1618. 

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-... 

A collaborative VA study (364) found that the addition of imipramine or a monoamine oxidase inhibitor to CPZ did not benefit chronic psychotic patients any more than CPZ alone. Further, the addition of an amphetamine was slightly harmful. This finding has since been replicated in several studies on apathetic schizophrenic patients (365). A study of chronic ambulatory schizophrenics compared amitriptyline plus perphenazine with perphenazine alone ( 366). While they found the combination slightly better in ameliorating depressive symptoms, it was at the cost of a slight increase in patients thought disorder. 

Prusoff BA, Williams DH, Weissman MM, et al. Treatment of secondary depression in schizophrenia. A double-blind, placebo-controlled trial of amitriptyline added to perphenazine. Arch Gen Psychiatry 1979 36 569-575. 

Hollister LE, Overall JE, Shelton J, et al. Drug therapy of depression. Amitriptyline, perphenazine, and their combination in different syndromes. Arch Gen Psychiatry 1967 17 486-493. 

Anton RF, Burch EA. Amoxapine versus amitriptyline combined with perphenazine in the treatment of psychotic depression. Am J Psychiatry 1990 147 1203-1208. 

A. G. Butterfield and R. W. Sears, High-pressure liquid chromatographic determination of perphenazine and amitriptyline hydrochloride in two-component tablet formulations, J. Pharm. Sci., 66 1117(1977). 

Berger and Wilson also reported the separation of 10 antidepressants (amitriptyline, imipramine, nortriptyline, desipramine, protripyline, bucliz-ine, benactyzine, hydroxyzine, perphenazine, and thioridazine) using a packed-column SFC with a tertiary mobile phase [37], A Lichrosphere cyanopropyl column with a mobile phase consisting of supercritical fluid carbon dioxide with 10% modifier (methanol with 0.5% isopropylamine) was used for the separation. It was noted that solutes did not elute without the addition of isopropylamine. Detection limits obtained were as low as 88 ppb for a 5-jul injection. 

A 50-year-old woman with an electroencephalographic abnormality but no history of epilepsy, who had taken amitriptyline and perphenazine uneventfully for years, suffered two seizures 18 days after switching to trazodone 50 mg/day. 

A 68-year-old man, who had been taking lorazepam, perphenazine, and amitriptyline for many years, developed acute thrombocytopenic purpura after combination therapy of chlordiazepoxide 5 mg and clidinium 2.5 mg tds for irritable bowel syndrome (2). His disease improved after withdrawal of chlordiazepoxide and clidinium and treatment with intravenous prednisolone. 

CYP2D6 Antidepressants amitriptyline, clomipramine, imipramine, desipramine, nortriptyline, trimipramine, N-desmethyl-clomipramine, fluoxetine, norfluoxetine, paroxetine, venlafaxine, sertraline Neuroleptics chlorpromazine, thioridazine, perphenazine, haloperidol, reduced haloperidol, risperidone, clozapine, sertindole Others codeine, opiate, propranolol, dextromethorphan 4 no activity 25% in Caucasians 0%-10% in others 5 no activity 2%-10% in all groups 10 reduced activity 47%-70% in Asians <5% in others 17 reduced activity 25%-40% in blacks 0% in others 2XN increased activity 19%-29% in Arabs and Ethiopians <5% in others... 

Note Etrafon and Triavil are combinations of perphenazine and amitriptyline... 

Clinically important, potentially hazardous interactions with amiodarone, amisulpride, amitriptyline, amoxapine, arsenic, bepridil, bretylium, calcium, chlorpromazine, clomipramine, desipramine, disopyramide, doxepin, erythromycin, fluphenazine, imipramine, iron salts, magnesium, mesoridazine, nortriptyline, pentamidine, perphenazine, phenothiazines, pimozide, procainamide, prochlorperazine, promazine, promethazine, protriptyline, quinidine, sotalol, sucralfate, thioridazine, tricyclic antidepressants, trifluoperazine, trimipramine, zinc salts... 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

Jalal, I.M. Sa sa, S.I. Khalil, H.S. Simultaneous high performance liquid chromatographic determination of amitriptyline hydrochloride and perphenazine in tablet formulations. J.Liq.Chromatogn, 1988, 11, 1531-1544 [tablets simultaneous perphenazine naphthalene (IS)]... 

Simultaneous amitriptyline, amobarbital, butalbital, carbamazepine, chlordiazepoxide, chlorpromazine, clonazepam, demoxepam, desipramine, diazepam, ethinamate, fluraze-pam, glutethimide, heptobarbital, hexobarbital, lidocaine, medazepam, meperidine, mephobarbital, mesoridazine, methaqualone, pentathal, nortriptyline, oxazepam, pentobarbital, perphenazine, phenytoin, promazine, propranolol, protriptyline, quinidine, secobarbital... 

Simultaneous metabolites, amitriptyline, carbamazepine, chlorprothixene, clomipramine, levomepromazine, nortriptyline Interfering mianserine, perphenazine, zuclopenthixol... 

Extracted amitriptyline, chlordiazepoxide, chlorpromeizine, desipramine, desmethldiaze-pam, desmethylchlordiazepoxide, desmethyldoxepin, doxepin, fluphenazine, haloperidol, nortriptyline, oxazepam, thiothixene Noninterfering molindone, perphenazine, trifluoperazine Interfering imipramine... 

Also analyzed acetaminophen, alprazolam, amitriptyline, amoxapine, carbamazepine, chlordiazepoxide, chlorpromazine, chlorprothixene, clonazepam, demoxepam, desipra-mine, diphenhydreiniine, disop3n amide, doxepin, ethotoin, durazepam, glutethimide, hal-operidol, haloperidol, imipramine, lidocaine, lorazepam, loxapine, maprotiline, mesantoin, mesoridetzine, methaqualone, methotrimeprazine, nordiazepam, nortriptyline, oxazepam, pentazocine, perphenazine, phenacetin, phenobarbital, phen3doin, promazine, promethazine, propranolol, protriptyline, salicylic acid, thiothixene, trifluoperazine, trifluproma-zine, trimipramine... 

Simultaneous amitriptyline, caffeine, carbamazepine, chlordiazepoxide, chlorpromazine, clonazepam, desipramine, flunitrazepam, flimazepam, haloperidol, imipramine, levome-promazine, maprotiline, mianserin, nitrazepam, nortriptyhne, perphenazine, phenobar-bital, phen5d oin, sulpride, thioridazine, triazolam... 

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