• Schizophrenia.
• Nausea and vomiting.

Unlabeled Uses:

• Other psychotic disorders, bipolar disorder.

Contraindicated in:

• Hypersensitivity (cross-sensitivity with other phenothiazines may occur)
• Angle-closure glaucoma
• Pre-existing bone marrow depression or blood dyscrasias
• Severe liver or cardiovascular disease
• Intestinal obstruction
• Lactation: Discontinue drug or bottle feed.

Use Cautiously in:

• Diabetes mellitus
• Respiratory disease
• Prostatic hyperplasia
• CNS tumors
• History of seizure disorder
• Patients at risk for falls
• Geri: Geriatric, emaciated, or debilitated patients (one half- to one third of usual initial dose recommended); ↑ risk of mortality in elderly patients treated for dementia-related psychosis
• OB: Pedi: Safety not established.

CNS: NEUROLEPTIC MALIGNANT SYNDROME, extrapyramidal reactions, sedation, tardive dyskinesia.

EENT: blurred vision, dry eyes, lens opacities.

CV: hypotension, tachycardia.

GI: constipation, dry mouth, anorexia, ileus, weight gain.

GU: discoloration of urine, urinary retention.

Derm: photosensitivity, pigment changes, rashes.

Endo: galactorrhea, amenorrhea.

Hemat: AGRANULOCYTOSIS, leukopenia.

Metab: hyperthermia.
Misc: allergic reactions.

Drug-Drug:

• Additive hypotension with antihypertensives, acute ingestion of alcohol, or nitrates.
• Additive CNS depression with MAO inhibitors or other CNS depressants, including alcohol, antihistamines, opioid analgesics, sedative/hypnotics, and general anesthetics.
• Additive anticholinergic effects with other drugs possessing anticholinergic properties, including antihistamines, antidepressants, atropine, disopyramide, haloperidol, and other phenothiazines.
• Hypotension and tachycardia may occur with epinephrine.
• ↑risk of agranulocytosis with other agents that cause bone marrow suppression, including antithyroid agents.
• ↑risk of extrapyramidal reactions with lithium.
• May mask lithium toxicity.
• Antacids or lithium may ↓ absorption of perphenazine.
• May ↓ antiparkinson effect of levodopa or bromocriptine.

Drug-Natural Products:

• ↑anticholinergic effects with angel's trumpet, jimson weed, and scopolia.

(Generic available)

• Tablets: 2 mg; 4 mg; 8 mg; 16 mg;

• PO (Adults): Schizophrenia — 2–16 mg 2–4 times daily (not to exceed 64 mg/day). Nausea/vomiting — 8–16 mg/day in divided doses (not to exceed 24 mg/day).

Trilafon

• Alters the effects of dopamine in the CNS.
• Possesses significant anticholinergic and alpha-adrenergic blocking activity.
• Blocks dopamine in the chemoreceptor trigger zone (CTZ).

• Diminished signs and symptoms of psychoses.
• Decreased nausea, vomiting, or hiccups.

Therapeutic Classification: antiemetics, antipsychotics (conventional)

Pharmacologic Classification: phenothiazines

Absorption: Absorption from tablet is poor (approximately 20%) and variable; may be better with oral liquid formulations.

Distribution: Widely distributed, high concentrations in the CNS; crosses the placenta and enters breast milk.

Protein Binding: 90%.

Metabolism/Excretion: Mostly metabolized by the liver (CYP2D6 isoenzyme);the CYP2D6 enzyme system exhibits genetic polymorphism; 7% of population may be poor metabolizers (PMs) and may have significantly ↑ perphenazine concentrations and an ↑ risk of adverse effects.

Half-life: 8.4–12.3 hr.

(antipsychotic effect†)

†Optimal antipsychotic response may not occur for several wk.

• Advise patient to take medication as directed and not to skip doses or double up on missed doses. Take missed doses as soon as remembered unless almost time for the next dose. If more than 2 doses/day are ordered, the missed dose should be taken within 1 hr of the scheduled time or omitted. Abrupt withdrawal may lead to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia.
• Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately.
• Advise patient to make position changes slowly to minimize orthostatic hypotension. Protect from falls.
• Medication may cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
• Advise patient to use sunscreen and protective clothing when exposed to the sun. Exposed surfaces may develop a blue-gray pigmentation, which may fade following discontinuation of the medication. Extremes in temperature should also be avoided, because this drug impairs body temperature regulation.
• Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth. Consult health care professional if dry mouth continues for >2 wk.
• Advise patient not to take perphenazine within 2 hr of antacids or antidiarrheal medication.
• Inform patient that this medication may turn urine a pink to reddish-brown color.
• Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
• Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, visual disturbances, dark-colored urine, or clay-colored stools occur.
• Emphasize the importance of routine follow-up exams to monitor response to medication and detect side effects.
• Encourage continued participation in psychotherapy.

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