Yes

Antidepressant, Tricyclic (Tertiary Amine)

Treatment of patients with moderate to severe anxiety and depression

D

Pregnancy and lactation; hypersensitivity to amitriptyline, perphenazine, or any component, cross-sensitivity with other phenothiazines may exist; angle-closure glaucoma; bone marrow depression; severe liver or cardiac disease

Safe use of tricyclic antidepressants in children <12 years of age has not been established; amitriptyline should not be abruptly discontinued in patients receiving high doses for prolonged periods; do not drink alcoholic beverages

Cardiovascular: Arrhythmias, hypotension

Central nervous system: Dizziness, drowsiness, headache, confusion, delirium, insomnia, nervousness, restlessness, parkinsonian syndrome, hallucinations, anxiety, seizures

Dermatologic: Alopecia, photosensitivity

Endocrine & metabolic: Sexual dysfunction, breast enlargement, galactorrhea, SIADH

Gastrointestinal: Constipation, xerostomia, increased appetite, nausea, weight gain, unpleasant taste, diarrhea, heartburn, trouble with gums, decreased lower esophageal sphincter tone may cause GE reflux

Genitourinary: Dysuria, testicular edema

Hematologic: Agranulocytosis, leukopenia, eosinophilia

Hepatic: Cholestatic jaundice, increased liver enzymes

Neuromuscular & skeletal: Weakness, fine muscle tremors

Ocular: Blurred vision, eye pain, increased intraocular pressure

Otic: Tinnitus

Miscellaneous: Diaphoresis (excessive), allergic reactions

Decreased effect of guanethidine

Increased effect and toxicity: Cimetidine ( metabolism), methyldopa, methylphenidate ( metabolism), propranolol; increased effect of CNS depressants (including tricyclic antidepressants) adrenergic agents, anticholinergic agents, warfarin; lithium and fluoxetine can toxicities

Increased toxicity of MAO inhibitors (hyperpyrexia, tachycardia, hypertension, confusion, seizures, and death have been reported), clonidine (hypertensive crisis)

Antacids, anticholinergics, barbiturates, and carbamazepine can decrease effect

Phenothiazines decrease effect of bromocriptine and valproic acid

Oral: 1 tablet 2-4 times/day

Amitriptyline: Use with caution; epinephrine, norepinephrine and levonordefrin have been shown to have an increased pressor response in combination with TCAs

Perphenazine: No information available to require special precautions

>10% of patients experience dry mouth

Perphenazine: Significant hypotension may occur, especially when the drug is administered parenterally; orthostatic hypotension is due to alpha-receptor blockade, the elderly are at greater risk for orthostatic hypotension

Tardive dyskinesia: Prevalence rate may be 40% in elderly; development of the syndrome and the irreversible nature are proportional to duration and total cumulative dose over time

Extrapyramidal reactions are more common in elderly with up to 50% developing these reactions after 60 years of age; drug-induced Parkinson's syndrome occurs often; Akathisia is the most common extrapyramidal reaction in elderly

Increased confusion, memory loss, psychotic behavior, and agitation frequently occur as a consequence of anticholinergic effects

Antipsychotic associated sedation in nonpsychotic patients is extremely unpleasant due to feelings of depersonalization, derealization, and dysphoria

See individual agent. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

Monitor blood pressure and pulse rate prior to and during initial therapy; evaluate mental status; monitor weight; may increase appetite and possibly a craving for sweets; offer patient sugarless hard candy for dry mouth

Tablet:

4-10: Amitriptyline hydrochloride 10 mg and perphenazine 4 mg

2-25: Amitriptyline hydrochloride 25 mg and perphenazine 2 mg

4-25: Amitriptyline hydrochloride 25 mg and perphenazine 4 mg

4-50: Amitriptyline hydrochloride 50 mg and perphenazine 4 mg

Boakes AJ, Laurence DR, Teoh PC, et al, "Interactions Between Sympathomimetic Amines and Antidepressant Agents in Man," Br Med J, 1973, 1(849):311-5.

Jastak JT and Yagiela JA, "Vasoconstrictors and Local Anesthesia: A Review and Rationale for Use," J Am Dent Assoc, 1983, 107(4):623-30.

Larochelle P, Hamet P, and Enjalbert M, "Responses to Tyramine and Norepinephrine After Imipramine and Trazodone," Clin Pharmacol Ther, 1979, 26(1):24-30.

Mitchell JR, "Guanethidine and Related Agents. III Antagonism by Drugs Which Inhibit the Norepinephrine Pump in Man," J Clin Invest, 1970, 49(8):1596-604.

Rundegren J, van Dijken J, Mörnstad H, et al, "Oral Conditions in Patients Receiving Long-Term Treatment With Cyclic Antidepressant Drugs," Swed Dent J, 1985, 9(2):55-64.

Svedmyr N, "The Influence of a Tricyclic Antidepressive Agent (Protriptyline) on Some of the Circulatory Effects of Noradrenaline and Adrenalin in Man," Life Sci, 1968, 7(1):77-84.