• Schizophrenia.
• Nausea and vomiting.

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: Lactation.

Use Cautiously in:

• Diabetes mellitus
• Respiratory disease
• Prostatic hyperplasia
• CNS tumors
• Seizure disorder
• At risk for falls
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk
• Pedi: Safety and effectiveness not established in children
• Geri: Appears on Beers list. ↑ risk of stroke, cognitive decline, and mortality in older adults with dementia. Avoid use in older adults, except for schizophrenia or short-term use as an antiemetic.

CV: hypotension, tachycardia.

Derm: photosensitivity, pigment changes, rash.

EENT: blurred vision, dry eyes, lens opacities.

Endo: galactorrhea, amenorrhea.

GI: constipation, dry mouth, anorexia, ileus.

GU: urinary retention, urine discoloration.

Hemat: AGRANULOCYTOSIS, leukopenia.

Metab: hyperthermia, weight gain.

Neuro: extrapyramidal reactions, NEUROLEPTIC MALIGNANT SYNDROME, sedation, tardive dyskinesia.
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;

Schizophrenia

• PO (Adults): 2–16 mg 2–4 times daily (not to exceed 64 mg/day).

Nausea/Vomiting

• PO (Adults): 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 and vomiting.

Therapeutic Classification: antiemetics, antipsychotics (conventional)

Pharmacologic Classification: phenothiazines

Absorption: 20% absorbed following oral administration.

Distribution: Widely distributed, high concentrations in the CNS.

Protein Binding: 90%.

Metabolism/Excretion: Mostly metabolized by the liver via the CYP2D6 isoenzyme;the CYP2D6 isoenzyme exhibits genetic polymorphism; 7% of population may be poor metabolizers 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.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding. Advise patients that use during 3rd trimester may cause extrapyramidal and/or withdrawal symptoms (agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder).
• Emphasize the importance of routine follow-up exams to monitor response to medication and detect side effects.

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