Perphenazine Side Effects

Some side effects of perphenazine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to perphenazine: oral tablet

Get emergency medical help if you have any of these signs of an allergic reaction while taking perphenazine: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using perphenazine and call your doctor at once if you have a serious side effect such as:

• twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;

• tremor (uncontrolled shaking), drooling, trouble swallowing, problems with balance or walking;

• feeling restless, jittery, or agitated;

• confusion, unusual thoughts or behavior;

• feeling like you might pass out;

• seizure (convulsions);

• decreased night vision, tunnel vision, watery eyes, increased sensitivity to light;

• nausea and stomach pain, skin rash, and jaundice (yellowing of the skin or eyes);

• high fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing;

• pale skin, easy bruising or bleeding, fever, sore throat, flu symptoms;

• urinating less than usual or not at all;

• joint pain or swelling with fever, swollen glands, muscle aches, chest pain, vomiting, unusual thoughts or behavior, and patchy skin color; or

• slow heart rate, weak pulse, fainting, slow breathing (breathing may stop).

Less serious side effects of perphenazine may include:

• dizziness, drowsiness, anxiety;

• blurred vision, headache;

• sleep problems (insomnia), strange dreams;

• constipation;

• dry mouth or stuffy nose;

• breast swelling or discharge;

• changes in your menstrual periods;

• weight gain, swelling in your hands or feet;

• impotence, trouble having an orgasm; or

• mild itching or skin rash.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

For Healthcare Professionals

Applies to perphenazine: compounding powder, injectable solution, oral concentrate, oral tablet

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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