Increased Mortality in Elderly Patients with Dementia-Related Psychosis
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Perphenazine and amitriptyline hydrochloride is not approved for the treatment of patients with dementia-related psychosis (see WARNINGS).
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.
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. 
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)
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.
Reducing Weight Gain and Improving Metabolic Function in Children Being Treated With Antipsychotics [Recruiting]
This study will test the effectiveness of two different treatments for children and
adolescents who have gained weight on their antipsychotic medications.
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]
Decision Aid to Facilitate Shared Decision Making During Treatment in Schizophrenia [Recruiting]
We hypothesize that the use of a visual decision aid tool to educate patients regarding
potential harm with respect to weight gain with olanzapine versus perphenazine can lead to
better shared decision making by patients, increase rates of antipsychotic switches and
promote weight loss in overweight patients with schizophrenia/schizoaffective disorder.
Our specific aims are the following:
1. To investigate the effects of a visual decision aid, versus care as usual, on patients'
perceived difficulties in medical decision making regarding switching antipsychotics in
overweight veterans with schizophrenia or schizoaffective disorder.
2. To investigate the effects of a visual decision aid and a shared decision making model
on rate of medication switches (from olanzapine to perphenazine) in overweight veterans
with schizophrenia or schizoaffective disorder.
3. To investigate the effects of a visual decision making aid and shared decision making
model on BMI in overweight veterans who switch from olanzapine to perphenazine therapy.
15 Month Study for Adults Who Have Been Diagnosed With Schizophrenia and Incarcerated [Recruiting]
The study will assess the use of paliperidone palmitate compared with oral antipsychotic
treatment in delaying time to a protocol-defined treatment failure over 15 months, in
patients diagnosed with schizophrenia who have been incarcerated
Page last updated: 2007-06-01