Perphenazine and Amitriptyline (Systemic)

Brand Names : Etrafon, Etrafon-A, Etrafon-Forte, Triavil, Elavil Plus, Etrafon-D, Etrafon-F, PMS Levazine

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For perphenazine and amitriptyline combination, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to perphenazine (e.g., Trilafon) or other phenothiazines (such as acetophenazine [e.g., Tindal], chlorpromazine [e.g., Thorazine], fluphenazine [e.g., Prolixin], mesoridazine [e.g., Serentil], prochlorperazine [e.g., Compazine], promazine [e.g., Sparine], promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril], trifluoperazine [e.g., Stelazine], triflupromazine [e.g., Vesprin], trimeprazine [e.g., Temaril]) or to amitriptyline (e.g., Elavil) or other tricyclic antidepressants (such as amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]). Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy - Studies have not been done in pregnant women. However, perphenazine and amitriptyline combination has not been shown to cause birth defects in animal studies. Side effects such as jaundice and muscle tremors have occurred in some newborn babies when their mothers received other phenothiazines during pregnancy.

Breast-feeding - Perphenazine and amitriptyline combination passes into the breast milk and may cause drowsiness and other unwanted effects in nursing babies.

Children - Certain side effects, such as muscle spasms of the face, neck, and back, tic-like or twitching movements, inability to move the eyes, twisting of the body, or weakness of the arms and legs, are more likely to occur in children, who are usually more sensitive than adults to some of the side effects of perphenazine and amitriptyline combination.

Older adults - Confusion, vision problems, dizziness or fainting, drowsiness, dryness of mouth, constipation, problems in urinating, trembling of the hands and fingers, and symptoms of tardive dyskinesia (such as uncontrolled movements of the mouth, tongue, jaw, arms, and/or legs) are especially likely to occur in elderly patients. Older patients are usually more sensitive than younger adults to the effects of perphenazine and amitriptyline combination.

Other medicines - Although certain medicines should not be used together at all, in other cases 2 different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking perphenazine and amitriptyline combination, it is especially important that your health care professional know if you are taking any of the following:

• Amphetamines or
• Appetite suppressants (diet pills) or
• Medicine for asthma or other breathing problems or
• Medicine for colds, sinus problems, or hay fever or other allergies (including nose drops and sprays) - Using these medicines with perphenazine and amitriptyline combination may increase the risk of serious effects on the heart

• Antithyroid agents (medicine for overactive thyroid) or
• Cimetidine (e.g., Tagamet) or
• Methyldopa (e.g., Aldomet) or
• Metoclopramide (e.g., Reglan) or
• Metyrosine (e.g., Demser) or
• Pemoline (e.g., Cylert) or
• Pimozide (e.g., Orap) or
• Promethazine (e.g., Phenergan) or
• Rauwolfia alkaloids (alseroxylon [e.g., Rauwiloid], deserpidine [e.g., Harmonyl], rauwolfia serpentina [e.g., Raudixin], reserpine [e.g., Serpasil]) or
• Trimeprazine (e.g., Temaril) - Taking these medicines with perphenazine and amitriptyline combination may increase the risk of serious side effects

• Central nervous system (CNS) depressants (medicines that cause drowsiness) - Taking these medicines with perphenazine and amitriptyline combination may increase the CNS depressant effects

• Epinephrine (e.g., Adrenalin) - Severe low blood pressure (hypotension) and fast heartbeat may occur if epinephrine is used with perphenazine and amitriptyline combination

• Levodopa (e.g., Dopar) - Perphenazine may prevent levodopa from working properly in the treatment of Parkinson's disease

• Lithium (e.g., Lithane) - The amount of medicine you need to take may change

• Metrizamide - When this dye is used for myelograms during the use of perphenazine and amitriptyline combination, there is an increased risk of seizures

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) - Taking amitriptyline while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may cause sudden high body temperature, extremely high blood pressure, and severe convulsions; however, sometimes certain of these medicines may be used together under close supervision by your doctor

Other medical problems - The presence of other medical problems may affect the use of perphenazine and amitriptyline combination. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse - Certain side effects such as heat stroke may be more likely to occur

• Asthma (history of) or other lung disease or
• Bipolar disorder (manic-depressive illness) or
• Blood disease or
• Breast cancer or
• Difficult urination or
• Enlarged prostate or
• Epilepsy or other seizure disorders or
• Glaucoma or
• Heart or blood vessel disease or
• Mental illness (severe) or
• Parkinson's disease or
• Stomach or intestinal problems - Perphenazine and amitriptyline combination may make the condition worse

• Kidney disease or
• Liver disease - Higher blood levels of perphenazine and amitriptyline may occur, increasing the chance of side effects

• Overactive thyroid - Perphenazine and amitriptyline combination may cause an increased chance of serious effects on the heart

• Reye's syndrome - There may be an increased chance of unwanted effects on the liver