Perphenazine; Amitriptyline Tablets

What is this medication?

PERPHENAZINE; AMITRIPTYLINE (per FEN a zeen; a mee TRIP ti leen) treats depression and anxiety. It may also be used to treat schizophrenia. It works by increasing levels of dopamine, norepinephrine, and serotonin in your brain, substances that help regulate mood, behaviors, and thoughts. It is a combination of an antipsychotic and a tricyclic antidepressant (TCA). Antipsychotic medications can be used to treat several kinds of mental health conditions.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Etrafon, Etrafon-A, Triavil

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Bipolar disorder
• Blockage in your bowel
• Dementia
• Diabetes
• Difficulty swallowing
• Glaucoma
• Have trouble controlling your muscles
• Head injury
• Heart disease
• If you often drink alcohol
• Kidney disease
• Liver disease
• Low blood counts, like low white cell, platelet, or red cell counts
• Low blood pressure
• Lung or breathing disease, like asthma
• Parkinson's disease
• Pheochromocytoma
• Seizures
• Suicidal thoughts, plans or attempt; a previous suicide attempt by you or a family member
• Thyroid disease
• Trouble passing urine
• An unusual or allergic reaction to amitriptyline, perphenazine, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

Take this medication by mouth with a glass of water. Follow the directions on the prescription label. You can take this medication with or without food. Take your doses at regular intervals. Do not take your medication more often than directed. Do not stop taking this medication suddenly except upon the advice of your care team. Stopping this medication too quickly may cause serious side effects or your condition may worsen.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following:

• Linezolid
• MAOIs like Carbex, Marplan, Nardil, Parnate, and Xadago
• Methylene blue
• Metoclopramide

This medication may also interact with the following:

• Alcohol
• Antihistamines for allergy, cough, and cold
• Atropine
• Certain medication for bladder problems like oxybutynin, tolterodine
• Certain medications for depression, anxiety, or psychotic disorders
• Certain medications for irregular heart beat like amiodarone, dofetilide, encainide, flecainide, propafenone, quinidine
• Certain medications for sleep
• Certain medications for stomach problems like dicyclomine, hyoscyamine
• Certain medications for travel sickness like scopolamine
• Cimetidine
• Epinephrine
• Ethchlorvynol
• General anesthetics like halothane, isoflurane, methoxyflurane, propofol
• Ipratropium
• Levodopa or other medications for Parkinson's disease
• Lithium
• Medications for blood pressure
• Medications for seizures like phenobarbital, primidone, phenytoin
• Medications that relax muscles for surgery
• Narcotic medications for pain
• Topiramate

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if symptoms do not start to get better or if they get worse. Do not stop taking except on your care team's advice. You may develop a severe reaction. Your care team will tell you how much medication to take.

Patients and their families should watch out for new or worsening thoughts of suicide or depression. Also watch out for sudden changes in feelings such as feeling anxious, agitated, panicky, irritable, hostile, aggressive, impulsive, severely restless, overly excited and hyperactive, or not being able to sleep. If this happens, especially at the beginning of treatment or after a change in dose, call your care team.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medication affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medication. Avoid alcoholic drinks.

Do not treat yourself for coughs, colds, or allergies without asking your care team for advice. Some ingredients can increase possible side effects.

This medication may increase blood sugar. Ask your care team if changes in diet or medications are needed if you have diabetes.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water may help. Contact your care team if the problem does not go away or is severe.

This medication may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your eye doctor if the problem does not go away or is severe.

This medication can cause constipation. Try to have a bowel movement at least every 2 to 3 days. If you do not have a bowel movement for 3 days, call your care team.

This medication can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

This medication can cause problems with controlling your body temperature. It can lower the response of your body to cold temperatures. If possible, stay indoors during cold weather. If you must go outdoors, wear warm clothes. It can also lower the response of your body to heat. Do not overheat. Do not over-exercise. Stay out of the sun when possible. If you must be in the sun, wear cool clothing. Drink plenty of water. If you have trouble controlling your body temperature, call your care team right away.

If you are going to have surgery, tell your care team that you are taking this medication.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
• High prolactin level—unexpected breast tissue growth, discharge from the nipple, change in sex drive or performance, irregular menstrual cycle
• Infection—fever, chills, cough, or sore throat
• Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
• Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
• Thoughts of suicide or self-harm, worsening mood, feelings of depression
• Uncontrolled and repetitive body movements, muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, restlessness, shuffling walk, which may be signs of extrapyramidal symptoms (EPS)

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Change in sex drive or performance
• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Weight gain

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Protect from light. Keep container tightly closed. Throw away any unused medication after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.