Perphenazine Side Effects

Please note - some side effects for Perphenazine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Perphenazine - for the Consumer

Perphenazine

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Perphenazine:

Appetite loss; blurred vision; confusion; constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; nasal congestion; nausea; sleeplessness; tired feeling; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in breasts; changes in menstrual period; changes in vision or other vision problems; chest pain; difficulty speaking; difficulty swallowing; fainting; fast, slow, or irregular heartbeat; fever; inability to move eyes; inability to urinate; involuntary movements of the tongue, face, mouth, or jaw; lip smacking or puckering; mask-like face; mental confusion; muscle spasms of face, neck, or back; numbness of the arms and legs; prolonged or painful erection; puffing of cheeks; restlessness; seizures; severe stomach pain; shuffling walk or stiff arms or legs; sore throat; tension in leg; tightness in the throat or jaw; tremors of hands; twitching or twisting movements; unusual or excessive sweating; weakness of arms or legs; yellowing of skin or eyes.

Perphenazine Solution

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Perphenazine Solution:

Appetite loss; blurred vision; confusion; constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; nasal congestion; nausea; sleeplessness; tired feeling; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in breasts; changes in menstrual period; changes in vision; difficulty speaking; difficulty swallowing; inability to move eyes; lip smacking or puckering; mask-like face; mental confusion; muscle spasms of face, neck, or back; numbness of the arms and legs; prolonged or painful erection; puffing of cheeks; restlessness; seizures; shuffling walk or stiff arms or legs; sore throat; tension in leg; tightness in the throat or jaw; tremors of hands; twitching or twisting movements; vision problems; weakness of arms or legs.

Perphenazine Side Effects - for the Professional

Perphenazine

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.

Dystonia

Class effect:  Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue.While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.

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 the tongue, puffing of the 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.

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.

Side Effects by Body System

Nervous system

The incidence and severity of extrapyramidal reactions have been reported to increase with an increase in dosage. Extrapyramidal reactions have been reported to usually be controllable by concomitant use of an antiparkinsonian drug such as benztropine mesylate and/or by a reduction in dosage.

Risk of developing tardive dyskinesia has been reported to be greater in elderly patients on high-dose therapy, especially females. In some patients, the symptoms are irreversible.

Nervous system effects including extrapyramidal reactions such as 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 have been reported. Persistent and sometimes irreversible tardive dyskinesia, cerebral edema, abnormality of cerebrospinal fluid proteins, convulsive seizures,drowsiness, and headaches have also been reported. Neuroleptic malignant syndrome has been reported in patients treated with neuroleptic drugs.

Other

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

Gastrointestinal

Gastrointestinal effects including dry mouth, salivation, nausea, vomiting, diarrhea, anorexia, constipation, obstipation, and fecal impaction have been reported. Adynamic ileus (sometimes fatal) has occasionally been reported.

Genitourinary

Genitourinary effects including urinary retention, frequency, incontinence, bladder paralysis, priapism, and polyuria have been reported.

Respiratory

Respiratory effects including asthma, laryngeal edema, and nasal congestion have been reported. Sudden death caused by asphyxia due to failure of the cough reflex has occasionally been reported.

Other

Other effects including pallor and perspiration have been reported.

Ocular

Ocular effects including myosis, mydriasis, blurred vision, and glaucoma have been reported. Two cases of oculogyric crisis have also been reported.

Cardiovascular

Cardiovascular effects including hypertension, hypotension, tachycardia, bradycardia, cardiac arrest, faintness, dizziness, and change in pulse rate have been reported. The hypotensive effect has occasionally been reported to produce a shock-like condition, ECG changes, a nonspecific and usually reversible quinidine-like effect. Sudden death due to cardiac arrest has occasionally been reported.

Dermatologic

Dermatologic effects including urticaria, erythema, eczema, exfoliative dermatitis, pruritus, angioneurotic edema, and photosensitivity have been reported.

General

General effects including fever have been reported.

Local

Local effects including contact dermatitis in nursing personnel administering the drug have been reported.

Hypersensitivity

Hypersensitivity or individual idiosyncrasy to phenothiazines has extremely rarely been reported to lead to cerebral edema, circulatory collapse, and death.

Endocrine

Endocrine effects including lactation, galactorrhea, moderate breast enlargement in females and gynecomastia in males on large doses, disturbances in the menstrual cycle, amenorrhea, change in libido, inhibition of ejaculation, syndrome of inappropriate antidiuretic hormone secretion, false positive pregnancy tests, hyperglycemia, hypoglycemia, and glycosuria have been reported.

Hematologic

Hematologic effects including agranulocytosis, eosinophilia, leukopenia, hemolytic anemia, thrombocytopenic purpura, and pancyopenia have been reported.

Most cases of agranulocytosis have been reported to occur between the fourth and tenth weeks of therapy. Therefore, close monitoring for the sudden appearance of sore throat or other signs of infection are recommended. Discontinuation of therapy is recommended if white blood cell and differential cell counts show significant cellular depression.

Hepatic

Hepatic effects including biliary stasis have been reported. Jaundice has usually been reported between the second and fourth weeks of therapy.

Perphenazine-related jaundice is regarded as a hypersensitivity reaction.

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