Psychosis perphenazine

Chlorpromazine, Reserpine, Promazine, Acetylpromazine Perphenazine, Trifluoperazine, Fluphenazine Psychosis... 

Perphenazine doubled clozapine concentrations in a 46-year-old male smoker, with paradoxical myoclonus, hypersalivation, and worsening of psychosis (261). The mechanism of this effect is not known perphenazine is a substrate for CYP2D6, but that is not important in the metabolism of clozapine. 

A 28-year-old man, without a psychiatric history, developed a paranoid psychosis. He had been taking levamisole twice a week in an unspecified dose for 2 years for a stage 4 melanoma and metastatic lymph nodes in the axilla. Physical examination, a CT scan, an electroencephalogram, and standard laboratory tests were all normal. He was treated with perphenazine, with partial success, but after tapering of the dose his symptoms reappeared. It was thought likely that the psychosis had been caused by levamisole, which was discontinued. Three weeks later he had recovered completely. Levamisole was not reintroduced. 

After first trimester carbamazepine, lamotrigine, oxcarbazepine, or valproate Second choice benzodiazepine (lorazepam) Third choice calcium channel blocker With psychosis first choice adjunctive high-potency typical antipsychotic (haloperidol, perphenazine, thiothixene, or trifluoperazine)... 

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