perphenazine (redirected from phenazine)

perphenazine /per·phen·a·zine/ (-fen´ah-zēn) a phenothiazine used as an antipsychotic and as an antiemetic.

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per·phen·a·zine (pr-fn-zn)

n.

A crystalline compound used as a tranquilizer especially in the treatment of psychosis and to prevent or alleviate nausea and vomiting.

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perphenazine

[pərfen′əzēn]

a phenothiazine derivative used as an antipsychotic and antiemetic/antivertigo agent.

indications It is prescribed in the treatment of schizophrenia and in the control of severe nausea and vomiting in adults. Unlabeled uses include treatment of ethanol withdrawal, Huntington's chorea, Tourette's syndrome, spasmodic torticollis, and dementia in the elderly.

contraindications Parkinson's disease, the concurrent administration of central nervous system depressants, liver or renal dysfunction, severe hypotension, bone marrow depression, blood dyscrasias, or known hypersensitivity to any phenothiazine prohibits its use.

adverse effects Among the more serious adverse effects are hypotension, liver toxicity, extrapyramidal reactions, blood dyscrasias, and hypersensitivity reactions.

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perphenazine (prfen´zēn´),

n brand name: Trilafon;
drug class: phenothiazine antipsychotic;
action: blocks neurotransmission at dopaminergic synapses in the cerebral cortex, hypothalamus, and limbic system; mechanism for antipsychotic effects unclear;
uses: psychotic disorders, schizophrenia, alcoholism, nausea, vomiting.

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perphenazine

a phenothiazine compound used as a tranquilizer and antiemetic.

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perphenazine

Apo-Perphenazine (CA), Fentazin (UK), Phenazine (CA)

Pharmacologic class: Phenothiazine, dopaminergic antagonist

Therapeutic class: Antipsychotic, antiemetic

Pregnancy risk category NR

Action

Unknown. Thought to antagonize dopamine and serotonin type 2 in CNS. Also antagonizes muscarinic receptors in respiratory tract, causing cholinergic activation.

Availability

Injection: 5 mg/ml

Oral concentrate: 16 mg/5 ml

Tablets: 2 mg, 4 mg, 8 mg, 16 mg

⊘Indications and dosages

➣ Schizophrenia in nonhospitalized patients

Adults and children older than age 12: Initially, 4 to 8 mg P.O. t.i.d.

➣ Schizophrenia in hospitalized patients

Adults and children older than age 12: Initially, 8 to 16 mg P.O. two to four times daily, increased p.r.n.; avoid dosages greater than 64 mg daily. Or 5 to 10 mg by deep I.M. injection q 6 hours p.r.n., not to exceed 30 mg/day.

➣ Severe nausea and vomiting

Adults: 8 to 16 mg P.O. daily in divided doses, to a maximum of 24 mg; or 5 to 10 mg by deep I.M. injection p.r.n.; or up to 5 mg I.V. by slow injection or infusion.

Off-label uses

• Intractable hiccups

Contraindications

• Hypersensitivity to drug, its components, or related compounds
• Blood dyscrasias
• Bone marrow depression
• Hepatic damage
• Subcortical damage
• Coma
• Concurrent use of high-dose CNS depressants

Precautions

Use cautiously in:
• respiratory disorders, hepatic or renal dysfunction, breast cancer, alcohol withdrawal symptoms, suicidal tendency, surgery
• patients taking CNS depressants or anticholinergics
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 12.

Administration

• Give oral forms with food to avoid GI upset.
• Dilute oral solution in water or fruit juice just before giving; use at least 60 ml of diluent for each 5 ml of solution.
• Avoid contact with oral or injection solution; contact dermatitis may occur.
• Administer I.M. injection deep into upper outer aspect of buttocks. Massage site to prevent abscess.
• Know that I.V. route is rarely indicated and should be used only in recumbent hospitalized patients. For I.V. use, dilute with normal saline solution to a concentration of 0.5 mg/ml; give slowly (no more than 1 mg q 2 minutes). I.V. dose shouldn't exceed 5 mg.
• Replace parenteral therapy with oral therapy as soon as possible.

Route	Onset	Peak	Duration
P.O.	Variable	1-3 hours	Unknown
I.M., I.V.	5-10 min	1-2 hr	6 hr

Adverse reactions

CNS: drowsiness, dizziness, insomnia, vertigo, headache, hyperactivity, nocturnal confusion, bizarre dreams, tremor, ataxia, slurring, exacerbation of psychotic symptoms, paranoid reactions, parkinsonism, dystonias, akathisia, tardive dyskinesia, hyperreflexia, cerebrospinal fluid abnormality, catatonic-like state, paradoxical stimulation, seizures, neuroleptic malignant syndrome

CV: hypotension, orthostatic hypotension, hypertension, peripheral edema, ECG changes, tachycardia, bradycardia, cardiac arrest, heart failure

EENT: glaucoma, blurred vision, miosis, mydriasis, corneal and lens deposits, pigmentary retinopathy, oculogyric crisis, photophobia, nasal congestion, dysphagia

GI: nausea, vomiting, diarrhea, constipation, obstipation, abnormal tongue color or movement, dry mouth, anorexia, adynamic ileus

GU: dark urine, urinary retention, urinary frequency, urinary incontinence, bladder paralysis, galactorrhea, lactation, breast enlargement, menstrual irregularities, inhibited ejaculation, libido changes

Hematologic: hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenic purpura

Hepatic: jaundice, biliary stasis

Metabolic: hyponatremia, glycosuria, hyperglycemia, hypoglycemia, syndrome of inappropriate antidiuretic hormone secretion, pituitary tumor

Musculoskeletal: numbness and aching of arms and legs

Respiratory: dyspnea, suppressed cough reflex, asthma, bronchospasm, laryngospasm, laryngeal edema

Skin: urticaria, pallor, erythema, eczema, pruritus, perspiration, pigmentation changes, photosensitivity, angioedema, exfoliative dermatitis

Other: increased appetite, weight gain, fever, systemic lupus erythematosus-like syndrome, pain at I.M. injection site, hypersensitivity reactions including anaphylactoid reaction

Interactions

Drug-drug. Anticholinergics: increased risk of adverse anticholinergic reactions

CNS depressants: increased perphenazine effects, increased adverse CNS reactions

Tricyclic antidepressants: increased perphenazine blood level, greater risk of adverse reactions

Drug-diagnostic tests. Eosinophils, liver function tests: increased values

Glucose: increased or decreased level

Granulocytes, hemoglobin, platelets, sodium, white blood cells: decreased levels

Pregnancy test: false-positive result

Drug-herbs. Kava: dystonic reactions

St. John's wort: photosensitivity

Yohimbe: yohimbe toxicity

Drug-behaviors. Alcohol use: increased CNS depression

Sun exposure: increased risk of photosensitivity reaction

Patient monitoring

☞ Watch for anaphylactoid reaction and angioedema. Monitor neurologic status; stay alert for signs and symptoms of neuroleptic malignant syndrome (high fever, unstable blood pressure, stupor, muscle rigidity, autonomic dysfunction), parkinsonian symptoms, and catatonic-like state.
• Assess blood pressure and heart rate continuously during I.V. use. Monitor cardiovascular status and vital signs periodically.
☞ Evaluate respiratory status, especially for dyspnea and airway spasm.
☞ Monitor CBC, glucose level, and liver function tests. Watch for evidence of blood dyscrasias.

Patient teaching

• Explain importance of combining drug therapy with psychotherapy.
• Tell patient to take exactly as prescribed and to report adverse reactions promptly.
• Instruct patient to avoid sun exposure and to wear sunscreen outdoors to prevent photosensitivity reaction.
• Advise patient to consult prescriber before taking other prescription drugs or over-the-counter preparations.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects him.
• Instruct patient to avoid alcohol, smoking, caffeine, and herbs.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

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perphenazine

Etrafon, Trilafon^® Pharmacology A phenothiazine and tricyclic antidepressant combination used to manage anxiety, depression, agitation, severe N&V, hiccups, pain Adverse effects Extrapyramidal symptoms–involuntary movement–opisthotonus, trismus, torticollis, retrocollis, aching, numbness of limbs, motor restlessness, oculogyric crisis, hyperreflexia, dystonia, sedative effects, jaundice, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenic purpura, pancytopenia. See Mitriptyline.