Suicidality and Antidepressant Drugs
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of perphenazine and amitriptyline or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Perphenazine and amitriptyline is not approved for use in pediatric patients. (See WARNINGS: Clinical Worsening and Suicide Risk, PRECAUTIONS: Information for Patients and PRECAUTIONS: Pediatric Use.)
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SUMMARY
Perphenazine and amitriptyline HCl, a broad-spectrum psychotherapeutic agent for the management of outpatients and hospitalized patients with psychoses or neuroses characterized by mixtures of anxiety or agitation with symptoms of depression, is a combination of perphenazine and amitriptyline HCl. Since such mixed syndromes can occur in patients with various degrees of intensity of mental illness, perphenazine and amitriptyline HCl tablets are provided in multiple combinations to afford dosage flexibility for optimum management. Perphenazine is a phenothiazine derivative. The formula is 4-[3-(2-chloro-10 H -phenothiazin-10yl) propyl]-piperazineethanol. It is a white, odorless, bittertasting powder that is insoluble in water.
Perphenazine and amitriptyline HCl is recommended for treatment of (1) patients with moderate to severe anxiety and/or agitation and depressed mood, (2) patients with depression in whom anxiety and/or agitation are severe, and (3) patients with depression and anxiety in association with chronic physical disease. In many of these patients, anxiety masks the depressive state so that, although therapy with a tranquilizer appears to be indicated, the administration of a tranquilizer alone will not be adequate.
Schizophrenic patients who have associated depressive symptoms should be considered for therapy with perphenazine and amitriptyline HCl.
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NEWS HIGHLIGHTS
Published Studies Related to Perphenazine and Amitriptyline (Perphenazine / Amitriptyline)
Induction of the rabbit syndrome following coadministration of paroxetine, perphenazine, and amitriptyline. [2004.11]
The authors present a case of paroxetine-induced rabbit syndrome in a 65-year-old white woman. To their knowledge, this is the first report in the literature describing rabbit syndrome induced by the administration of a selective serotonin reuptake inhibitor-specifically, paroxetine in combination with perphenazine and amitriptyline..
Simultaneous dissolution profiles of two drugs, sulfadiazine-trimethoprim and amitriptyline-perphenazine, in solid oral dosage forms by a FIA manifold provided with a single spectrophotometric detector. [2002.10.15]
The simultaneous determination of two dissolution profiles wih the aid of a flow injection analysis assembly has been applied to: (a) sulfadiazine-trimethoprim in tablets and (b) amitriptyline-perphenazine in sugar coated pills. The selected combinations are drugs which have overlapping UV-vis spectra...
Amoxapine versus amitriptyline combined with perphenazine in the treatment of psychotic depression. [1990.09]
In a double-blind study lasting for 4 weeks, the authors compared the effectiveness of amoxapine, an antidepressant with potential antipsychotic properties, with a combination of amitriptyline plus perphenazine in the treatment of 38 patients who had the diagnosis of major depression with psychotic features (psychotic or delusional depression)...
Metabolic interaction between amitriptyline and perphenazine in psychiatric patients. [1979]
1. Steady-state plasma level samples of sixty-five schizophrenic patients from two psychiatric hospitals assigned to three treatment groups (amitriptyline 150 mg/day, perphenazine 20 mg/day and a combination of amitriptyline and perphenazine at 150 mg and 20 mg/day) were assayed for amitriptyline (AT), endogenous nortriptyline (NT) and perphenazine (PPZ) using gas-liquid chromatography.
Clinical Trials Related to Perphenazine and Amitriptyline (Perphenazine / Amitriptyline)
A Double-Blind, Controlled Study of Aripiprazole in Co-Morbid Schizophrenia and Cocaine Dependence [Recruiting]
The purpose of this study is to gather systematic clinical data on whether aripiprazole, a
partial dopamine agonist, beneficially affects schizophrenia plus cocaine dependence
subjects. Since aripiprazole has established effects against schizophrenia, the study
focuses on whether aripiprazole concurrently reduces co-morbid cocaine dependence in
schizophrenia plus cocaine dependence sufferers compared to a standard typical antipsychotic
treatment (perphenazine). The working hypothesis states that subjects in the aripiprazole
treatment arm of the study will give fewer cocaine positive urine specimens as compared to
the perphenazine control arm.
Aripiprazole for Co-Morbid Schizophrenia and Cocaine Dependence [Recruiting]
The purpose of this study is to gather systematic clinical data on whether aripiprazole, a
partial dopamine agonist, beneficially affects schizophrenia plus cocaine dependence
(SCHZ+CD) subjects. Since aripiprazole has established effects against SCHZ, the study
focuses on whether aripiprazole concurrently ameliorates co-morbid CD in SCHZ+CD sufferers
compared to a standard typical antipsychotic treatment (perphenazine). The working
hypothesis states that subjects in the aripiprazole treatment arm of the study will yield
fewer cocaine positive urine specimens as compared to the perphenazine control arm.
A Positron Emission Tomography (PET) Study to Assess the Degree of Dopamine-2 (D2) Receptor Occupancy in the Human Brain After Single Doses of BL-1020 or Perphenazine in Healthy Male Subjects Using [11C]Raclopride as PET Tracer [Recruiting]
Serotonergic Pharmacotherapy for Agitation of Dementia [Completed]
This study is a randomized, double-blind, placebo-controlled, fixed dose study currently
being conducted on two geropsychiatric units at Western Psychiatric Institute and Clinic. It
seeks to evaluate the short-term safety and efficacy of citalopram and perphenazine in the
treatment of 112 patients suffering from behavioral disturbances associated with dementia.
Findings from this research may directly lead to improved acute pharmacotherapy for psychosis
and behavioral problems in patients diagnosed with dementia. Improved treatment of behavioral
complications with reduced side effects would reduce excess disability in patients diagnosed
with dementia, allowing them to be maintained in the community for greater periods of time.
CATIE- Schizophrenia Trial [Completed]
The CATIE Schizophrenia Trial is part of the Clinical Antipsychotic Trials of Intervention
Effectiveness (CATIE) Project. The schizophrenia trial is being conducted to determine the
long-term effects and usefulness of antipsychotic medications in persons with schizophrenia.
It is designed for people with schizophrenia who may benefit from a medication change. The
study involves the newer atypical antipsychotics (olanzapine, quetiapine, risperidone,
clozapine, and ziprasidone)and the typical antipsychotics (perphenazine and fluphenazine
decanoate). All participants will receive an initial comprehensive medical and psychiatric
evaluation and will be closely followed throughout the study. For most participants the study
will last up to 18 months. Everyone in the study will be offered an educational program about
schizophrenia and family members will be encouraged to participate.
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Page last updated: 2007-06-01
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