A Cochrane review [Abstract] 1 included 7 studies with a total of 479 participants. The majority of randomised participants had schizophrenia. Five studies were from inpatient settings, 6 trials had a one-month and one study 3-month follow-up. The dose of perazine ranged between 75 and 1000 mg/day. In one trial (n=95), perazine appeared superior to 'active placebo' (trimipramine) at 5 weeks for the outcome of 'no important global improvement' (RR 0.43 CI 0.2 to 0.8), but there was no statistically significant difference in most measures of mental state. Perazine did not induce more general adverse events than placebo but more participants received at least one dose of antiparkinson medication (RR 4.50 CI 1.0 to 19.5). Six small trials (n=384) comparing perazine with other antipsychotics were incompletely reported, so meta-analysis was not possible. In these studies, a similar number of participants receiving perazine or comparator antipsychotics (amisulpride, haloperidol, olanzapine, ziprasidone, zotepine) left the studies early (RR 0.97 CI 0.68 to 1.38). No obvious differences in adverse events between perazine and other antipsychotics could be derived from the limited data. Two haloperidol comparisons did not present extrapyramidal side-effects in a way that was suitable for use in meta-analysis, but 3 small comparisons (n=111) with the second-generation antipsychotics zotepine and amisulpride showed no higher risk of akathisia (RR 0.31 CI 0.1 to 1.1), dyskinesia (RR 0.47 CI 0.1 to 3.5), parkinsonism (RR 1.21 CI 0.5 2.8; n = 81) or tremor (RR 0.80 CI 0.3 to 2.6; n = 40) with perazine.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), indirectness (6 studies conducted in one country, 5 studies conducted in inpatient setting, short follow-up time) and imprecise results (small study size for each comparison).
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