Perphenazine (Perphenazine) - Side Effects and Adverse Reactions

ADVERSE REACTIONS

Not all of the following adverse reactions have been reported with this specific drug; however, pharmacological similarities among various phenothiazine derivatives require that each be considered. With the piperazine group (of which perphenazine is an example), the extrapyramidal symptoms are more common, and others (e.g., sedative effects, jaundice, and blood dyscrasias) are less frequently seen.

CNS Effects

Extrapyramidal Reactions

opisthotonus, trismus, torticollis, retrocollis, aching and numbness of the limbs, motor restlessness, oculogyric crisis, hyperreflexia, dystonia, including protrusion, discoloration, aching and rounding of the tongue, tonic spasm of the masticatory muscles, tight feeling in the throat, slurred speech, dysphagia, akathisia, dyskinesia, parkinsonism, and ataxia. Their incidence and severity usually increase with an increase in dosage, but there is considerable individual variation in the tendency to develop such symptoms. Extrapyramidal symptoms can usually be controlled by the concomitant use of effective antiparkinsonian drugs, such as benztropine mesylate, and/or by reduction in dosage. In some instances, however, these extrapyramidal reactions may persist after discontinuation of treatment with perphenazine.

Persistent Tardive Dyskinesia

As with all antipsychotic agents, tardive dyskinesia may appear in some patients on long-term therapy or may appear after drug therapy has been discontinued. Although the risk appears to be greater in elderly patients on high-dose therapy, especially females, it may occur in either sex and in children. The symptoms are persistent and in some patients appear to be irreversible. The syndrome is characterized by rhythmical, involuntary movements of the tongue, face, mouth or jaw (e.g., protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements). Sometimes these may be accompanied by involuntary movements of the extremities. There is no known effective treatment for tardive dyskinesia; antiparkinsonism agents usually do not alleviate the symptoms of this syndrome. It is suggested that all antipsychotic agents be discontinued if these symptoms appear. Should it be necessary to reinstitute treatment, or increase the dosage of the agent, or switch to a different antipsychotic agent, the syndrome may be masked. It has been reported that fine, vermicular movements of the tongue may be an early sign of the syndrome, and if the medication is stopped at that time the syndrome may not develop.

Other CNS Effects

include cerebral edema; abnormality of cerebrospinal fluid proteins; convulsive seizures, particularly in patients with EEG abnormalities or a history of such disorders; and headaches.

Neuroleptic malignant syndrome has been reported in patients treated with antipsychotic drugs (see WARNINGS).

Drowsiness may occur, particularly during the first or second week, after which it generally disappears. If troublesome, lower the dosage. Hypnotic effects appear to be minimal, especially in patients who are permitted to remain active.

Adverse behavioral effects include paradoxical exacerbation of psychotic symptoms, catatonic-like states, paranoid reactions, lethargy, paradoxical excitement, restlessness, hyperactivity, nocturnal confusion, bizarre dreams, and insomnia.

Hyperreflexia has been reported in the newborn when a phenothiazine was used during pregnancy.

Autonomic Effects

dry mouth or salivation, nausea, vomiting, diarrhea, anorexia, constipation, obstipation, fecal impaction, urinary retention, frequency or incontinence, bladder paralysis, polyuria, nasal congestion, pallor, myosis, mydriasis, blurred vision, glaucoma, perspiration, hypertension, hypotension, and change in pulse rate occasionally may occur. Significant autonomic effects have been infrequent in patients receiving less than 24 mg perphenazine daily.

Adynamic ileus occasionally occurs with phenothiazine therapy, and if severe, can result in complications and death. It is of particular concern in psychiatric patients, who may fail to seek treatment of the condition.

Allergic Effects

urticaria, erythema, eczema, exfoliative dermatitis, pruritus, photosensitivity, asthma, fever, anaphylactoid reactions, laryngeal edema, and angioneurotic edema; contact dermatitis in nursing personnel administering the drug; and in extremely rare instances, individual idiosyncrasy or hypersensitivity to phenothiazines has resulted in cerebral edema, circulatory collapse, and death.

Endocrine Effects

lactation, galactorrhea, moderate breast enlargement in females and gynecomastia in males on large doses, disturbances in the menstrual cycle, amenorrhea, changes in libido, inhibition of ejaculation, syndrome of inappropriate ADH (antidiuretic hormone) secretion, false positive pregnancy tests, hyperglycemia, hypoglycemia, glycosuria.

Cardiovascular Effects

postural hypotension, tachycardia (especially with sudden marked increase in dosage), bradycardia, cardiac arrest, faintness, and dizziness. Occasionally the hypotensive effect may produce a shock-like condition. ECG changes, nonspecific (quinidine-like effect) usually reversible, have been observed in some patients receiving phenothiazine antipsychotics.

Sudden death has occasionally been reported in patients who have received phenothiazines. In some cases, the death was apparently due to cardiac arrest; in others, the cause appeared to be asphyxia due to failure of the cough reflex. In some patients, the cause could not be determined nor could it be established that the death was due to the phenothiazine.

Hematological Effects

agranulocytosis, eosinophilia, leukopenia, hemolytic anemia, thrombocytopenic purpura, and pancytopenia. Most cases of agranulocytosis have occurred between the fourth and tenth weeks of therapy. Patients should be watched closely, especially during that period, for the sudden appearance of sore throat or signs of infection. If white blood cell and differential cell counts show significant cellular depression, discontinue the drug and start appropriate therapy. However, a slightly lowered white count is not in itself an indication to discontinue the drug.

Other Effects

Special considerations in long-term therapy include pigmentation of the skin, occurring chiefly in the exposed areas; ocular changes consisting of deposition of fine particulate matter in the cornea and lens, progressing in more severe cases to star-shaped lenticular opacities; epithelial keratopathies; and pigmentary retinopathy. Also noted: peripheral edema, reversed epinephrine effect, increase in PBI not attributable to an increase in thyroxine, parotid swelling (rare), hyperpyrexia, systemic lupus erythematosus-like syndrome, increases in appetite and weight, polyphagia, photophobia, and muscle weakness.

Liver damage (biliary stasis) may occur. Jaundice may occur, usually between the second and fourth weeks of treatment, and is regarded as a hypersensitivity reaction. Incidence is low. The clinical picture resembles infectious hepatitis but with laboratory features of obstructive jaundice. It is usually reversible; however, chronic jaundice has been reported.

REPORTS OF SIDE EFFECTS / ADVERSE REACTIONS RELATED TO PERPHENAZINE

Possible Perphenazine side effects / adverse reactions in 52 year old male

Reported by a physician from Japan on 2007-01-26

Patient: 52 year old male weighing 52.0 kg (114.4 pounds)

Reactions: Weight Decreased, Dysphagia, Anaemia, Cerebral Atrophy, Parkinsonism, Speech Disorder, Dysstasia, Bipolar I Disorder, Insomnia, Anorexia

Adverse event resulted in: hospitalization

Suspect drug(s):
PEG-Intron
    Dosage: 100 mcg;qw;sc
    Indication: Hepatitis C
    Start date: 2006-05-12
    End date: 2006-09-07

Rebetol
    Dosage: see image
    Administration route: Oral
    Indication: Hepatitis C
    Start date: 2006-05-12
    End date: 2006-06-14

Rebetol
    Dosage: see image
    Administration route: Oral
    Indication: Hepatitis C
    Start date: 2006-06-15
    End date: 2006-09-07

Dogmatyle (Sulpiride)
    Dosage: 150 mg; po
    Administration route: Oral
    Indication: Bipolar I Disorder
    Start date: 2006-08-31
    End date: 2006-09-21

Dogmatyle (Sulpiride)
    Dosage: 150 mg; po
    Administration route: Oral
    Indication: Insomnia
    Start date: 2006-08-31
    End date: 2006-09-21

Perphenazine
    Dosage: 2 mg; po
    Administration route: Oral
    Indication: Bipolar I Disorder
    Start date: 2006-07-13
    End date: 2006-09-21

Perphenazine
    Dosage: 2 mg; po
    Administration route: Oral
    Indication: Insomnia
    Start date: 2006-07-13
    End date: 2006-09-21

Contmin (Clorpromazine)
    Dosage: 12.5 mg; po
    Administration route: Oral
    Indication: Bipolar I Disorder
    Start date: 2004-11-09
    End date: 2006-09-21

Contmin (Clorpromazine)
    Dosage: 12.5 mg; po
    Administration route: Oral
    Indication: Insomnia
    Start date: 2004-11-09
    End date: 2006-09-21

Possible Perphenazine side effects / adverse reactions in 51 year old female

Reported by a consumer/non-health professional from United States on 2007-03-12

Patient: 51 year old female

Reactions: Nasopharyngitis, Hallucination, Auditory, Drug Interaction, Hallucination, Hunger

Suspect drug(s):
Amaryl
    Start date: 2006-12-02

Risperdal
    Dosage: dose: unk

Perphenazine
    Dosage: dose: unk

Clindamycin
    Dosage: dose: unk
    End date: 2007-03-02

Other drugs received by patient: Metformin HCL; Metformin HCL; Artane; Artane; Razadyne; Lisinopril; Prozac; Coricidin /00070002/

Possible Perphenazine side effects / adverse reactions in female

Reported by a physician from United States on 2007-03-12

Patient: female

Reactions: Hyperlipidaemia, Diabetes Mellitus, Ovarian Cyst, Blood Triglycerides Increased, Blood Cholesterol Increased, Neuroleptic Malignant Syndrome

Adverse event resulted in: hospitalization

Suspect drug(s):
Seroquel
    Dosage: 100-200 mg
    Administration route: Oral
    Indication: Depression
    Start date: 2005-10-01
    End date: 2005-12-01

Seroquel
    Dosage: 100-200 mg
    Administration route: Oral
    Indication: Mental Disorder
    Start date: 2005-10-01
    End date: 2005-12-01

Abilify
    Start date: 2004-01-01
    End date: 2005-01-01

Geodon
    Start date: 2005-01-01

Risperdal
    Start date: 2004-03-01
    End date: 2005-08-01

Thorazine
    Start date: 1993-01-01
    End date: 1994-01-01

Perphenazine
    Start date: 2004-01-01
    End date: 2005-01-01

Lexapro

Trazodone HCL

Effexor

Paxil

Ativan

Buspar

Etrafan

Remeron

Other drugs received by patient: Lamictal