Perphenazine

Mechanism :

Piperazine phenothiazine antipsychotic which blocks dopamine, subtype 2 (D₂), receptors in mesolimbocortical and nigrostriatal areas of the brain.

Indication :

Schizophrenia
Nausea/vomiting
Off-label: Psychosis/agitation associated with dementia

Contraindications :

Hypersensitivity to perphenazine or any component of the formulation; severe CNS depression; subcortical brain damage with or without hypothalamic damage (known or suspected); bone marrow suppression; blood dyscrasias; liver damage.

Dosing :

Schizophrenia:

≥12 years:

8 to 16 mg/day PO in divided doses.

Adverse Effect :

Bradycardia, ECG changes, hypertension, hypotension, orthostatic hypotension, Bizarre dream, catatonic-like state, cerebral edema, confusion (nocturnal), disruption of body temperature regulation, dizziness, drowsiness, extrapyramidal reaction, neuroleptic malignant syndrome (NMS), paradoxical excitation, Diaphoresis, pallor, skin discoloration (blue-grey), Amenorrhea, change in libido, galactorrhea, glycosuria, gynecomastia, hyperglycemia, hypoglycemia, menstrual disease, SIADH, Anorexia, constipation, diarrhea, faecal impaction, increased appetite, Blurred vision, corneal changes, epithelial keratopathy, Hypersensitivity reaction, Lupus-like syndrome.

Interaction :

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents.
Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid.
Amisulpride: Antipsychotic Agents may enhance the adverse/toxic effect of Amisulpride.
Anti-Parkinson Agents (Dopamine Agonist): Antipsychotic Agents (First Generation [Typical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist).
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants.
CYP2D6 Inhibitors: May decrease the metabolism of CYP2D6 Substrates.
Opioid Analgesics: CNS Depressants may enhance the CNS depressant effect of Opioid Analgesics.
Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.

Hepatic Dose :

Phenothiazines are contraindicated in patients with significant hepatic impairment.