perphenazine and amitriptyline hydrochloride (Etrafon - brand no longer available in the US)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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What is amitriptyline w/ perphenazine-oral, and how does it work (mechanism of action)?

Perphenazine/amitriptyline is a combination of an antipsychotic and an antidepressant. Perphenazine is an antipsychotic that works in the brain and nervous system. Its exact mechanism of action is unknown. Amitriptyline is a tricyclic antidepressant. It is believed that in some patients with depression, abnormal levels of neurotransmitters (chemicals that nerves use to communicate with each other) may be related to their depression. Amitriptyline elevates mood by raising the level of neurotransmitters in nerves in the brain. The FDA approved perphenazine/amitriptyline in September 1969.

What brand names are available for amitriptyline w/ perphenazine-oral?

Etrafon (no longer available in the US)

Is amitriptyline w/ perphenazine-oral available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for amitriptyline w/ perphenazine-oral?

Yes

What are the side effects of amitriptyline w/ perphenazine-oral?

Side effects of Perphenazine/amitriptyline are abnormal muscle contractions, difficulty breathing and swallowing, neck spasms, and movement abnormalities on face, arms, and legs. This medication also causes dizziness, drowsiness, sedation, irregular heart rate and rhythm, increase or decrease in blood pressure, and blurred vision.

Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of antidepressants in a child or adolescent must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

Elderly patients with dementia related psychosis treated with antipsychotics are at an increased risk of death.

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What is the dosage for amitriptyline w/ perphenazine-oral?

  • Anxiety or agitation with depression: Initial dose is one tablet of 2/25 mg or 4/25 mg by mouth three to four times a day OR take one tablet of 4/50 mg by mouth twice a day.
  • Depression with schizophrenia: Initial dose is two tablets of 4/25 mg by mouth twice or three times a day, a fourth dose may be given at bedtime.
  • Maintenance dose for all patients: Take one tablet of 2/25 mg or 4/25 mg by mouth two to four times a day OR take one tablet of 4/50 mg by mouth twice a day. 2/10 mg and 4/10 mg doses can be used to increase flexibility in adjusting maintenance dosage to the lowest amount consistent with relief of symptoms.

The maximum dose is 16/200 mg per day.

Which drugs or supplements interact with amitriptyline w/ perphenazine-oral?

: Perphenazine/amitriptyline should be used with caution with medications like paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) because these medications also increase the concentration of neurotransmitters in the body leading to severe and deadly reactions.

Perphenazine/amitriptyline should be avoided with medications like quinidine, disopyramide (Norpace), procainamide (Pronestyl), propafenone (Rhythmol), and flecainide (Tambocor) because they may also affect heart rhythm and increase the risk of an irregular heart rate and rhythm.

Perphenazine/amitriptyline should be used with caution with medications like epinephrine due to increased risk of irregular heart rates and rhythms.

Is amitriptyline w/ perphenazine-oral safe to take if I'm pregnant or breastfeeding?

Perphenazine/amitriptyline enters breast milk and is not recommended during breastfeeding.

What else should I know about amitriptyline w/ perphenazine-oral?

What preparations of amitriptyline w/ perphenazine-oral are available?

Tablets: 2/10, 2/25, 4/10, 4/25, and 4/50 mg

How should I keep amitriptyline w/ perphenazine-oral stored?

Store Perphenazine/amitriptyline tablets at room temperature between 20 C to 25 C (68 F to 77 F). Protect the drug from light.

Medically reviewed by John Cunha, DO

REFERENCES:

FDA Prescribing Information.

Medscape. amitriptyline/perphenazine.

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Summary

Perphenazine and amitriptyline hydrochloride (Etrafon - brand no longer available in the US) is an antidepressant medication prescribed to treat depression and other mood or mental disorders. Side effects, drug interactions, dosage, storage, and pregnancy safety should be reviewed prior to using this supplement.

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Reviewed on 8/8/2017
References
Medically reviewed by John Cunha, DO

REFERENCES:

FDA Prescribing Information.

Medscape. amitriptyline/perphenazine.

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