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Etrafon (amitriptyline / perphenazine) Disease Interactions

There are 37 disease interactions with Etrafon (amitriptyline / perphenazine):

Major

Atypical Antipsychotic Agents (Includes Etrafon) ↔ Dementia

Severe Potential Hazard, High plausibility

Applies to: Dementia

Elderly patients with dementia- related psychosis treated with antipsychotic drugs are at an increased risk of death, mostly from cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) causes. A causal relationship with antipsychotic use has not been established. In controlled trials, treatment with some atypical antipsychotic drugs was also associated with an increased risk of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, in elderly patients with dementia- related psychosis. These agents are not approved for the treatment of patients with dementia- related psychosis.

Major

Perphenazine (Includes Etrafon) ↔ Liver Damage

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

The manufacturer considers the use of perphenazine to be contraindicated in patients with preexisting liver damage. Phenothiazines are extensively metabolized by the liver and may accumulate in patients with hepatic impairment.

Major

Phenothiazines (Includes Etrafon) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Alcoholism

The use of phenothiazines is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of phenothiazines may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with phenothiazines should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  2. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  5. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  6. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  8. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  9. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  10. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  11. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  12. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 13 references
Major

Phenothiazines (Includes Etrafon) ↔ Cardiovascular Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Pheochromocytoma, Dehydration

Phenothiazines may cause hypotension (including orthostatic hypotension), reflex tachycardia, increased pulse rate, syncope, and dizziness, particularly after the first parenteral dose but rarely after the first oral dose. Low-potency agents such as chlorpromazine and thioridazine are more likely to induce these effects, which usually subside within the first couple of hours following administration. Tolerance to the hypotensive effects often develops after a few doses. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include edema, thrombosis, and ECG abnormalities such as PR and QT interval prolongation, diffuse T-wave flattening, and ST segment depression. Therapy with phenothiazines should be avoided or otherwise administered cautiously in patients with severe cardiovascular disease, pheochromocytoma, a predisposition to hypotension, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. If parenteral therapy is given, patients should be in a supine position during administration and for at least 30 to 60 minutes afterwards. Patients who experience orthostatic hypotension should be cautioned not to rise too abruptly. Occasionally, when severe, hypotension may require treatment with vasoconstrictive agents such as norepinephrine or phenylephrine. Epinephrine should not be used, however, since phenothiazines can reverse its vasopressor effects and cause a further lowering of blood pressure.

References

  1. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. Jones J, Sklar D, Dougherty J, White W "Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache." JAMA 261 (1989): 1174-6
  3. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  6. Kumar BB "Letter: Acute hypotension from thioridazine." JAMA 234 (1975): 1321
  7. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  8. Witz L, Shapiro M, Shenkman L "Chlorpromazine induced fluid retention masquerading as idiopathic oedema." Br Med J 294 (1987): 807-8
  9. Margolis J "Massive edema induced by thioridazine (Mellaril): an unusual complication." J Am Geriatr Soc 20 (1972): 593-4
  10. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  11. Schreiber G, Belmaker R "In vivo differentiation of cardiac vagal blocking effects of chlorpromazine and haloperidol." Biol Psychiatry 22 (1987): 1417-21
  12. Varia I, Krishnan R, Davidson J "Deep-vein thrombosis with antipsychotic drugs." Psychosomatics 24 (1983): 1097-8
  13. Fletcher GF, Kazamias TM "Cardiotoxic effects of Mellaril: conduction disturbances and supraventricular arrhythmias." Am Heart J 78 (1969): 135-8
  14. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  15. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  16. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  17. Fruncillo R, Gibbons W, Vlasses P, Ferguson R "Severe hypotension associated with concurrent clonidine and antipsychotic medication." Am J Psychiatry 142 (1985): 274
  18. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  19. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  20. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  21. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  22. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  23. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  24. Stevenson R, Blanshard C, Patterson D "Ventricular fibrillation due to lithium withdrawal: an interaction with chlorpromazine?" Postgrad Med J 65 (1989): 936-8
View all 24 references
Major

Phenothiazines (Includes Etrafon) ↔ Cns Depression

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Respiratory Arrest

The use of phenothiazines is contraindicated in comatose patients and patients with severe central nervous system depression. Phenothiazines may potentiate the CNS and respiratory depression in these patients.

References

  1. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  7. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  9. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  11. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  12. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  13. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
View all 13 references
Major

Phenothiazines (Includes Etrafon) ↔ Head Injury

Severe Potential Hazard, High plausibility

Applies to: Head Injury

The use of phenothiazines is contraindicated in patients with suspected or established subcortical brain damage, with or without hypothalamic involvement. Phenothiazines can interfere with thermoregulatory mechanisms, and a hyperthermic reaction with temperatures in excess of 104 F may occur in such patients, sometimes not until 14 to 16 hours after drug administration.

References

  1. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  2. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  3. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  4. Keshavan MS, Kambhampati RK "Prolonged fever without extrapyramidal symptoms during neuroleptic treatment" J Clin Psychopharmacol 9 (1989): 230-1
  5. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  6. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  7. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  8. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  9. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. Dilsaver SC "Effects of neuroleptics on body temperature" J Clin Psychiatry 49 (1988): 78-9
  11. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  12. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
View all 13 references
Major

Tcas (Includes Etrafon) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

Applies to: Glaucoma/Intraocular Hypertension, Urinary Retention, Gastrointestinal Obstruction

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

References

  1. Remick RA, Keller FD, Buchanan RA, Gibson RE, Fleming JA "A comparison of the efficacy and safety of alprazolam and desipramine in depressed outpatients." Can J Psychiatry 33 (1988): 590-4
  2. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  3. Rosen J, Pollock BG, Altieri LP, Jonas EA "Treatment of nortriptyline's side effects in elderly patients: a double-blind study of bethanechol." Am J Psychiatry 150 (1993): 1249-51
  4. Claghorn JL, Feighner JP "A double-blind comparison of paroxetine with imipramine in the long-term treatment of depression." J Clin Psychopharmacol 13 (1993): S23-7
  5. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  6. Gershon S "Comparative side effect profiles of trazodone and imipramine: special reference to the geriatric population." Psychopathology 17 (1984): 39-50
  7. Guy W, McEvoy JM, Ban TA, Wilson WH, Pate K "A double-blind clinical trial of mianserin versus amitriptyline: differentiation by adverse symptomatology." Pharmacotherapy 3 (1983): 45-51
  8. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord 28 (1993): 71-9
  9. Ananth J, Assalian P, Links PS "Intolerable side effects of clomipramine." J Clin Psychopharmacol 2 (1982): 215-6
  10. Pedersen JH, Sorensen JL "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology 6 (1980): 42-7
  11. Ayd FJ, Jr "Long-term treatment of chronic depression: 15-year experience with doxepin HCl." J Clin Psychiatry 45 (1984): 39-46
  12. Hermesh H, Aizenberg D, Weizman A, Lapidot M, Munitz H "Clomipramine-induced urinary dysfunction in an obsessive-compulsive adolescent." Drug Intell Clin Pharm 21 (1987): 877-9
  13. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  14. Rudorfer MV, Young RC "Anticholinergic effects and plasma desipramine levels." Clin Pharmacol Ther 28 (1980): 703-6
  15. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  16. Remick RA, Campos PE, Misri S, Miles JE, Van Wyck, Fleet J "A comparison of the safety and efficacy of buproprion HCL and amitriptyline HCL in depressed outpatients." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 523-7
  17. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  18. Jenike MA, Baer L, Greist JH "Clomipramine versus fluoxetine in obsessive-compulsive disorder: a retrospective comparison of side effects and efficacy." J Clin Psychopharmacol 10 (1990): 122-4
  19. Bryant SG, Fisher S, Kluge RM "Long-term versus short-term amitriptyline side effects as measured by a postmarketing surveillance system." J Clin Psychopharmacol 7 (1987): 78-82
  20. Pigott TA, Pato MT, Bernstein SE, Grover GN, Hill JL, Tolliver TJ, Murphy DL "Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Behavioral and biological results." Arch Gen Psychiatry 47 (1990): 926-32
  21. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  22. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  23. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  24. Guillibert E, Pelicier Y, Archambault JC, Chabannes JP, Clerc G, Desvilles M, Guibert M, Pagot R, Poisat JL, Thobie Y "A double-blind, multicentre study of paroxetine versus clomipramine in depressed elderly patients." Acta Psychiatr Scand Suppl 350 (1989): 132-4
  25. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  26. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  27. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  28. Warnes H, Lehmann HE, Ban TA "Adynamic ileus during psychoactive medication: a report of three fatal and five severe cases." Can Med Assoc J 96 (1967): 1112-3
  29. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  30. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  31. Judd FK, Moore K, Norman TR, Burrows GD, Gupta RK, Parker G "A multicentre double blind trial of fluoxetine versus amitriptyline in the treatment of depressive illness." Aust N Z J Psychiatry 27 (1993): 49-55
  32. Georgotas A, McCue RE, Hapworth W, et al "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry 21 (1986): 1155-66
  33. Ritch R, Krupin T, Henry C, Kurata F "Oral imipramine and acute angle closure glaucoma." Arch Ophthalmol 112 (1994): 67-8
View all 33 references
Major

Tcas (Includes Etrafon) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: Cardiovascular Disease, Hyperthyroidism, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Dehydration

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

References

  1. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  3. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  4. Carpenter P, Gobel FL, Hulsing DJ "Desipramine cardiac toxicity." Minn Med 65 (1982): 231-4
  5. Ramanathan KB, Davidson C "Cardiac arrhythmia and imipramine therapy." Br Med J 1 (1975): 661-2
  6. Gross JS, Zwerin G "Left bundle branch block developing in a patient with sub-therapeutic nortriptyline levels: a case report." J Am Geriatr Soc 39 (1991): 1006-7
  7. Bluhm RE, Wilkinson GR, Shelton R, Branch RA "Genetically determined drug-metabolizing activity and desipramine- associated cardiotoxicity: a case report." Clin Pharmacol Ther 53 (1993): 89-95
  8. Appelbaum PS, Kapoor W "Imipramine-induced vasospasm: a case report." Am J Psychiatry 140 (1983): 913-5
  9. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  10. Christensen P, Thomsen HY, Pedersen OL, et al "Cardiovascular effects of amitriptyline in the treatment of elderly depressed patients." Psychopharmacology (Berl) 87 (1985): 212-5
  11. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  12. Kantor SJ, Glassman AH, Bigger JT, Jr Perel JM, Giardina EV "The cardiac effects of therapeutic plasma concentrations of imipramine." Am J Psychiatry 135 (1978): 534-8
  13. Dunn FG "Malignant hypertension associated with use of amitriptyline hydrochloride." South Med J 75 (1982): 1124-5
  14. Burrows GD, Vohra J, Hunt D, Sloman JG, Scoggins BA, Davies B "Cardiac effects of different tricyclic antidepressant drugs." Br J Psychiatry 129 (1976): 335-41
  15. Georgotas A, McCue RE, Hapworth W, et al "Comparative efficacy and safety of MAOIs versus TCAs in treating depression in the elderly." Biol Psychiatry 21 (1986): 1155-66
  16. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  17. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  18. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  19. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  20. Luchins DJ "Review of clinical and animal studies comparing the cardiovascular effects of doxepin and other tricyclic antidepressants." Am J Psychiatry 140 (1983): 1006-9
  21. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  22. Rudorfer MV, Young RC "Desipramine: cardiovascular effects and plasma levels." Am J Psychiatry 137 (1980): 984-6
  23. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  24. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  25. Robinson DS, Nies A, Corcella J, Cooper TB, Spencer C, Kefover R "Cardiovascular effects of phenelzine and amitriptyline in depressed outpatients." J Clin Psychiatry 43 (1982): 8-15
  26. Veith RC, Bloom V, Bielski R, Friedel RO "ECG effects of comparable plasma concentrations of desipramine and amitriptyline." J Clin Psychopharmacol 2 (1982): 394-8
  27. Strasberg B, Coelho A, Welch W, Swiryn S, Bauernfeind R, Rosen K "Doxepin induced torsade de pointes." Pacing Clin Electrophysiol 5 (1982): 873-7
  28. Roos JC "Cardiac effects of antidepressant drugs. A comparison of the tricyclic antidepressants and fluvoxamine." Br J Clin Pharmacol 15 Suppl 3 (1983): s439-45
  29. Faravelli C, Brat A, Marchetti G, Franchi F, Padeletti L, Michelucci A, Pastorino A "Cardiac effects of clomipramine treatment. ECG and left ventricular systolic time intervals." Neuropsychobiology 9 (1983): 113-8
  30. Van Sweden B "Rebound antidepressant cardiac arrhythmia." Biol Psychiatry 24 (1988): 363-4
  31. Laird LK, Lydiard RB, Morton WA, Steele TE, Kellner C, Thompson NM, Ballenger JC "Cardiovascular effects of imipramine, fluvoxamine, and placebo in depressed outpatients." J Clin Psychiatry 54 (1993): 224-8
  32. Linnoila M, Jobson KO, Gilliam JH, Paine RL "Effects of doxepin on blood pressure and heart rate in patients with primary major affective disorder ." J Clin Psychopharmacol 2 (1982): 433-4
  33. Young RC, Alexopoulos GS, Shamoian CA, Dhar AK, Kutt H "Heart failure associated with high plasma 10-hydroxynortriptyline levels." Am J Psychiatry 141 (1984): 432-3
  34. Feighner JP, Cohn JB, Fabre LF, Jr Fieve RR, Mendels J, Shrivastava RK, Dunbar GC "A study comparing paroxetine placebo and imipramine in depressed patients." J Affect Disord 28 (1993): 71-9
  35. Roose SP, Dalack GW, Glassman AH, Woodring S, Walsh BT, Giardina EG "Is doxepin a safer tricyclic for the heart?" J Clin Psychiatry 52 (1991): 338-41
  36. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  37. Pedersen JH, Sorensen JL "Therapeutic effect and side effects in patients with endogenous depression treated with oral nortriptyline once a day." Neuropsychobiology 6 (1980): 42-7
  38. Roose SP, Glassman AH, Siris SG, Walsh BT, Bruno RL, Wright LB "Comparison of imipramine- and nortriptyline-induced orthostatic hypotension: a meaningful difference." J Clin Psychopharmacol 1 (1981): 316-9
View all 38 references
Major

Tcas (Includes Etrafon) ↔ Pheochromocytoma

Severe Potential Hazard, Moderate plausibility

Applies to: Pheochromocytoma

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

References

  1. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  3. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  4. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  5. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  6. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  7. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  8. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  9. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  10. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  12. "Product Information. Remeron (mirtazapine)." Organon, West Orange, NJ.
View all 12 references
Major

Tricyclic Antidepressants (Includes Etrafon) ↔ Acute Myocardial Infarction Recovery

Severe Potential Hazard, Moderate plausibility

Applies to: Myocardial Infarction

The use of most tricyclic antidepressants is contraindicated in patients that are going through the acute recovery period after a myocardial infarction.

Major

Tricyclic Antidepressants (Includes Etrafon) ↔ Cardiovascular Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease

Tricyclic antidepressants should be used with extreme caution in patients with evidence of cardiovascular disease because of the possibility of fluctuations in the blood pressure, arrhythmias, conduction defects, tachycardia, myocardial infarction and stroke. This also applies to patients who have family history of sudden death, cardiac dysrhythmias, or conduction disturbances. In some cases a gradual dose titration is recommended.

Major

Tricyclic Antidepressants (Includes Etrafon) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Depression

Adult and pediatric patients with depression may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Major

Tricyclic Antidepressants (Includes Etrafon) ↔ Seizure Disorders

Severe Potential Hazard, Moderate plausibility

Applies to: Alcoholism, CNS Disorder

Tricyclic antidepressants (TCAs), can lower the seizure threshold and trigger seizures. These drugs should be used with extreme caution in patients with a history of seizures, or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. Daily dose restrictions might apply for specific antidepressants. Physicians are encouraged to get additional dosing recommendations on the manufacturer's prescribing information.

References

  1. Pascual J, Combarros O, Berciano J "Partial status epilepticus following single low dose of chlorimipramine in a patient on MAO-inhibitor treatment." Clin Neuropharmacol 10 (1987): 565-7
  2. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  3. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  4. Robinson ML "Epileptic fit after clomipramine." Br J Psychiatry 132 (1978): 525-6
  5. Flechter S, Rabey JM, Regev I, Borenstein N, Vardi J "Convulsive attacks due to antidepressant drug overdoses: case reports and discussion." Gen Hosp Psychiatry 5 (1983): 217-21
View all 5 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Anticholinergic Effects

Moderate Potential Hazard, Moderate plausibility

Applies to: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary Retention

Phenothiazines have anticholinergic activity, to which elderly patients are particularly sensitive. Low-potency agents such as chlorpromazine and thioridazine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with phenothiazines should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.

References

  1. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  5. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  7. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  8. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  9. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  10. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  11. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
View all 11 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Breast Cancer

Moderate Potential Hazard, Moderate plausibility

Applies to: Breast Cancer

The chronic use of phenothiazines is associated with persistent elevations in prolactin levels. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Therapy with phenothiazines should be administered cautiously in patients with existing or suspected malignancy of the breast.

References

  1. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  5. Kane JM "Antipsychotic drug side effects: their relationship to dose." J Clin Psychiatry 46 (1985): 16-21
  6. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  7. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  9. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  11. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  12. Ristic PI, Ory SJ, Lurain JR "Endometrial adenocarcinoma associated with drug-induced hyperprolactinemia." Obstet Gynecol 67 (1986): s86-8
  13. Gift T, Plum K, Price M "Depot fluphenazine and plasma prolactin." Prog Neuropsychopharmacol Biol Psychiatry 9 (1985): 407-12
  14. Ash PR, Bouma D "Exaggerated hyperprolactinemia in response to thiothixene ." Arch Neurol 38 (1981): 534-5
  15. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  16. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
View all 16 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Dystonic Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: Dehydration, Hypocalcemia

Phenothiazines may cause acute, dose-related dystonic reactions secondary to central dopaminergic blockade. These reactions are characterized by spastic contraction of discrete muscle groups and may include torticollis, opisthotonos, carpopedal spasm, trismus, difficulty swallowing, perioral spasms with protrusion of the tongue, and oculogyric crisis. Onset is usually within 24 to 96 hours following initiation of therapy or an increase in dosage. Risk factors include young age, male gender, use of high-potency agents (e.g., fluphenazine, perphenazine, trifluoperazine), high dosages, and IM administration. Therapy with phenothiazines should be administered cautiously in patients, particularly children, with hypocalcemia or severe dehydration, since these patients may be more susceptible to dystonic reactions. Most symptoms subside within a few hours and are almost always reversible within 24 to 48 hours following withdrawal of therapy. However, severe reactions such as laryngospasm may be life-threatening and require appropriate supportive therapy. Parenteral administration of an anticholinergic antiparkinsonian agent (e.g., benztropine, trihexyphenidyl) or diphenhydramine usually produces a prompt response and may be given orally for short-term maintenance to prevent recurrence of symptoms if phenothiazine therapy must be continued.

References

  1. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  2. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  3. Wood G, Waters A "Prolonged dystonic reaction to chlorpromazine in myxoedema coma." Postgrad Med J 56 (1980): 192-3
  4. Singh H, Levinson DF, Simpson GM, Lo ES, Friedman E "Acute dystonia during fixed-dose neuroleptic treatment." J Clin Psychopharmacol 10 (1990): 389-96
  5. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  6. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  7. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  8. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  9. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  10. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  11. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  12. Reecer MV, Clinchot DM, Tipton DB "Drug-induced dystonia in a patient with C4 quadriplegia. Case report." Am J Phys Med Rehabil 72 (1993): 97-8
  13. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  14. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. Harries JR "Oculogyric crises due to phenothiazines." Br Med J 3 (1967): 241
  16. Lamont S "Acute reactions to phenothiazine derivatives." Br J Anaesth 44 (1972): 539-40
  17. Idzorek S "Antiparkinsonian agents and fluphenazine decanoate." Am J Psychiatry 133 (1976): 80-2
  18. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  19. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  20. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  21. Bailie GR, Nelson MV, Krenzelok EP, Lesar T "Unusual treatment response of a severe dystonia to diphenhydramine." Ann Emerg Med 16 (1987): 705-8
  22. Schumock GT, Martinez E "Acute oculogyric crisis after administration of prochlorperazine." South Med J 84 (1991): 407-8
  23. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  24. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  25. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
  26. Nahata MC, Clotz MA, Krogg EA "Adverse effects of meperidine, promethazine, and chlorpromazine for sedation in pediatric patients." Clin Pediatr (Phila) 24 (1985): 558-60
  27. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  28. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  29. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  30. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  31. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
View all 31 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Hematologic Toxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Phenothiazines may infrequently cause hematologic toxicity, including agranulocytosis, thrombocytopenia, eosinophilia, aplastic anemia, purpura, granulocytopenia, and hemolytic anemia. Mild leukopenia may occur frequently with large doses over prolonged periods but is generally reversible despite continued treatment. Therapy with phenothiazines should be administered cautiously, if at all, in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly, and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice. Most cases of agranulocytosis have occurred between the fourth and tenth weeks of therapy.

References

  1. Yassa R "Agranulocytosis in the course of phenothiazine therapy." J Clin Psychiatry 46 (1985): 341-3
  2. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  3. Holt RJ "Fluphenazine decanoate-induced cholestatic jaundice and thrombocytopenia." Pharmacotherapy 4 (1984): 227-9
  4. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. Rosenthal DS, Stein GF, Santos JC "Thioridazine agranulocytosis." JAMA 200 (1967): 81-2
  7. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  8. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  9. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  11. Aram H "Henoch-Schonlein purpura induced by chlorpromazine." J Am Acad Dermatol 17 (1987): 139-40
  12. Stein P, Inwood M "Hemolytic anemia associated with chlorpromazine therapy." Can J Psychiatry 25 (1980): 659-61
  13. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  14. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  15. Ben-Yehuda A, Bloom A, Lijhovetzky G, et al "Chlorpromazine-induced liver and bone marrow granulomas associated with agranulocytosis." Isr J Med Sci 26 (1990): 449-51
  16. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  17. Zengotita H, Holt R "Neuroleptic drug-induced coagulopathy: mechanism of reaction and duration of effect." J Clin Psychiatry 47 (1986): 35-7
  18. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  19. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  20. Young A, Kehoe R "Two cases of agranulocytosis on addition of a butyrophenone to a long-standing course of phenothiazine treatment." Br J Psychiatry 154 (1989): 710-12
  21. Holt R "Neuroleptic drug-induced changes in platelet levels." J Clin Psychopharmacol 4 (1984): 130-2
View all 21 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Nms

Moderate Potential Hazard, Moderate plausibility

Applies to: Neuroleptic Malignant Syndrome

The central dopaminergic blocking effects of phenothiazines may precipitate or aggravate a potentially fatal symptom complex known as Neuroleptic Malignant Syndrome (NMS). NMS is observed most frequently when high-potency neuroleptic agents like haloperidol or fluphenazine are administered intramuscularly but may occur with any agent possessing neuroleptic activity given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Phenothiazine therapy should not be initiated in patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of phenothiazines should be carefully considered, since NMS may recur.

References

  1. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  2. Rampertaap MP "Neuroleptic malignant syndrome." South Med J 79 (1986): 331-6
  3. Grunhaus L, Sancovici S, Rimon R "Neuroleptic malignant syndrome due to depot fluphenazine." J Clin Psychiatry 40 (1979): 99-100
  4. Zubenko G, Pope HG, Jr "Management of a case of neuroleptic malignant syndrome with bromocriptine." Am J Psychiatry 140 (1983): 1619-20
  5. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  6. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  7. Caroff SN "The neuroleptic malignant syndrome." J Clin Psychiatry 41 (1980): 79-83
  8. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  9. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  10. Dhib-Jalbut S, Hesselbrock R, Brott T, Silbergeld D "Treatment of the neuroleptic malignant syndrome with bromocriptine" JAMA 250 (1983): 484-5
  11. Tenenbein M "The neuroleptic malignant syndrome: occurrence in a 15-year-old boy and recovery with bromocriptine therapy." Pediatr Neurosci 12 (1985): 161-4
  12. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  14. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  15. Price W, Giannini A "A paradoxical response to chlorpromazine: a possible variant of the neuroleptic malignant syndrome." J Clin Pharmacol 23 (1983): 567-9
  16. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  17. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  18. Morris H, McCormick W, Reinarz J "Neuroleptic malignant syndrome." Arch Neurol 37 (1980): 462-3
  19. West D "Dangers of fluphenazine." Br J Psychiatry 117 (1970): 718-9
  20. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  21. Granato JE, Stern BJ, Ringel A, Karim AH, Krumholz A, Coyle J, Adler S "Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine." Ann Neurol 14 (1983): 89-90
  22. Manser TJ, Warner JF "Neuroleptic malignant syndrome associated with prochlorperazine." South Med J 83 (1990): 73-4
  23. Caroff S, Rosenberg H, Gerber JC "Neuroleptic malignant syndrome and malignant hyperthermia" Lancet 1 (1983): 244
  24. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
View all 24 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Parkinsonism

Moderate Potential Hazard, Moderate plausibility

Applies to: Parkinsonism

The use of phenothiazines is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Propylamino derivatives such as chlorpromazine, promazine, and triflupromazine may be more likely to induce these effects. Therapy with phenothiazines should be administered cautiously in patients with Parkinson's disease or parkinsonian symptoms.

References

  1. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  2. Edelstein H, Knight RT "Severe parkinsonism in two AIDS patients taking prochlorperazine." Lancet 2 (1987): 341-2
  3. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  4. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  6. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  9. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  11. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  12. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  13. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  14. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  15. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  16. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  17. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  18. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  19. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  20. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. Rajput A, Rozdilsky B, Hornykiewicz O, et al "Reversible drug-induced parkinsonism." Arch Neurol 39 (1982): 6446
  22. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  23. Lamb P, Mindham RH, Ezzat MA "Letter: Parkinsonism induced by fluphenazine decanoate." Lancet 1 (1976): 484
  24. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
View all 24 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Phenothiazines and their metabolites are excreted by the kidney. There are very limited data concerning the use of phenothiazines in patients with renal disease. Therapy with phenothiazines should be administered cautiously in patients with significantly impaired renal function. The manufacturers recommend periodic renal function tests for all patients during prolonged therapy.

References

  1. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  2. McAllister CJ, Scowden EB, Stone WJ "Toxic psychosis induced by phenothiazine administration in patients with chronic renal failure." Clin Nephrol 10 (1978): 191-5
  3. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  4. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  8. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  9. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  10. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  11. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  12. Taylor G, Houston JB, Shaffer J, Mawer G "Pharmacokinetics of promethazine and its sulphoxide metabolite after intravenous and oral administration to man." Br J Clin Pharmacol 15 (1983): 287-93
  13. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  14. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  16. Fabre J, Freudenreich J, de Duckert A, Pitton JS, Rudhardt M, Virieux C "Influence of renal insufficiency on the excretion of chloroquine, phenobarbital, phenothiazines and methacycline." Helv Med Acta 33 (1967): 307-16
View all 16 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Respiratory Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: Pulmonary Impairment

Phenothiazines may suppress the cough reflex. Therapy with phenothiazines should be administered cautiously in patients with chronic respiratory disorders, including severe asthma, emphysema, or acute respiratory tract infections.

References

  1. Bach N, Thung S, Schaffner F, Tobias H "Exaggerated cholestasis and hepatic fibrosis following simultaneous administration of chlorpromazine and sodium valproate." Dig Dis Sci 34 (1989): 1303-7
  2. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  4. Lok AS, Ng IO "Prochlorperazine-induced chronic cholestasis." J Hepatol 6 (1988): 369-73
  5. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  6. Dossing M, Andreasen B "Drug-induced liver disease in Denmark." Scand J Gastroenterol 17 (1982): 205-11
  7. Whitfield LR, Kaul PN, Clark ML "Chlorpromazine metabolism IX: pharmacokinetics of chlorpromazine following oral administration in man." J Pharmacokinet Biopharm 6 (1978): 187-96
  8. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  9. Moradpour D, Altorfer J, Flury R, Greminger P, Meyenberger C, Jost R, Schmid M "Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis." Hepatology 20 (1994): 1437-41
  10. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
  11. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  13. Chetty M, Moodley SV, Miller R "Important metabolites to measure in pharmacodynamic studies of chlorpromazine." Ther Drug Monit 16 (1994): 30-6
  14. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  15. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  16. Derby LE, Gutthann SP, Jick H, Dean AD "Liver disorders in patients receiving chlorpromazine or isoniazid." Pharmacotherapy 13 (1993): 353-8
  17. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  18. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  19. Dahl SG, Strandjord RE "Pharmacokinetics of chlorpromazine after single and chronic dosage." Clin Pharmacol Ther 21 (1977): 437-48
  20. Seeff L "Drug-induced chronic liver disease, with emphasis on chronic active hepatitis." Semin Liver Dis 1 (1981): 104-15
  21. Ben-Yehuda A, Bloom A, Lijhovetzky G, et al "Chlorpromazine-induced liver and bone marrow granulomas associated with agranulocytosis." Isr J Med Sci 26 (1990): 449-51
  22. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  23. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  24. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
View all 24 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Seizure Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: CNS Disorder

Phenothiazines can lower the seizure threshold and induce seizures, particularly when dosages are high or increased rapidly and during the initiation of therapy. Of the phenothiazines used in the treatment of psychosis, chlorpromazine appears to have the greatest epileptogenic potential, while fluphenazine and thioridazine have the least. Therapy with phenothiazines should be administered cautiously in patients with a history of seizures or other factors predisposing to seizures such as abnormal EEG, preexisting CNS pathology, or head trauma. Adequate anticonvulsant therapy should be maintained during administration of phenothiazines.

References

  1. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  2. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  3. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
  4. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  5. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  6. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  7. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  8. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  9. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  10. Waterhouse RG "Epileptiform convulsions in children following premedication with Pamergan SP100." Br J Anaesth 39 (1967): 268-70
  11. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  12. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  14. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  16. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  17. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  18. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 18 references
Moderate

Phenothiazines (Includes Etrafon) ↔ Tardive Dyskinesia

Moderate Potential Hazard, Moderate plausibility

Applies to: Tardive Dyskinesia

Phenothiazines may commonly precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Also, propylpiperazine derivatives like fluphenazine, perphenazine, prochlorperazine, and trifluoperazine may be more likely to induce this syndrome. Both the risk of developing TD and the likelihood that it will become irreversible increase with the duration and total cumulative dose of phenothiazine therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during phenothiazine therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms usually become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of phenothiazine therapy may temporarily mask the symptoms of TD but may eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.

References

  1. Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." Prog Neuropsychopharmacol Biol Psychiatry 7 (1983): 719-23
  2. Schwinghammer TL, Kroboth FJ, Juhl RP "Extrapyramidal reaction secondary to oral promethazine." Clin Pharm 3 (1984): 83-5
  3. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  4. Mukherjee S, Rosen AM, Cardenas C, Varia V, Olarte S "Tardive dyskinesia in psychiatric outpatients: a study of prevalence and association with demographic, clinical, and drug history variables." Arch Gen Psychiatry 39 (1982): 466-9
  5. "Product Information. Temaril (trimeprazine)" Allergan Inc, Irvine, CA.
  6. "Product Information. Sparine (promazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  8. "Product Information. Prolixin (fluphenazine)." Bristol-Myers Squibb, Princeton, NJ.
  9. Csernansky JG, Grabowski K, Cervantes J, Kaplan J, Yesavage JA "Fluphenazine decanoate and tardive dyskinesia: a possible association." Am J Psychiatry 138 (1981): 1362-5
  10. Yesavage JA, Tanke ED, Sheikh JI "Tardive dyskinesia and steady-state serum levels of thiothixene." Arch Gen Psychiatry 44 (1987): 913-5
  11. Yassa R, Iskandar H, Ally J "The prevalence of tardive dyskinesia in fluphenazine-treated patients." J Clin Psychopharmacol 8 (1988): 17S-20S
  12. "Product Information. Torecan (thiethylperazine)" Roxane Laboratories Inc, Columbus, OH.
  13. Baker FM, Cook P "Compazine complications: a review." J Natl Med Assoc 73 (1981): 409-12
  14. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  15. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  16. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
  17. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  18. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation, Buffalo, NY.
  19. "Product Information. Trilafon (perphenazine)" Schering Corporation, Kenilworth, NJ.
  20. Marcotte DB "Neuroleptics and neurologic reactions." South Med J 66 (1973): 321-4
  21. Curson DA, Barnes TR, Bamber RW, Platt SD, Hirsch SR, Duffy JC "Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial. II. The incidence of compliance problems,side-effects, neurotic symptoms and depression" Br J Psychiatry 146 (1985): 469-74
  22. "Product Information. Mellaril (thioridazine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  23. "Product Information. Stelazine (trifluoperazine)" SmithKline Beecham, Philadelphia, PA.
  24. Yassa R, Dimitry R "Single phenothiazines and tardive dyskinesia." J Clin Psychiatry 44 (1983): 233-4
  25. McClelland HA, Metcalfe AV, Kerr TA, Dutta D, Watson P "Facial dyskinesia: a 16-year follow-up study" Br J Psychiatry 158 (1991): 691-6
  26. Kolakowska T, Williams AO, Ardern M "Tardive dyskinesia and current dose of neuroleptic drugs" Arch Gen Psychiatry 42 (1985): 925
  27. "Product Information. Serentil (mesoridazine)" Boehringer-Ingelheim, Ridgefield, CT.
  28. "Product Information. Vesprin (triflupromazine)" Bristol-Myers Squibb, Princeton, NJ.
  29. Perenyi A, Arato M "Fluphenazine and tardive dyskinesia" Arch Gen Psychiatry 41 (1984): 727
  30. Glazer WM, Moore DC "The diagnosis of rapid abnormal involuntary movements associated with fluphenazine decanoate." J Nerv Ment Dis 168 (1980): 439-41
View all 30 references
Moderate

Tcas (Includes Etrafon) ↔ Bone Marrow Suppression

Moderate Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

The use of tricyclic and tetracyclic antidepressants (TCAs) has rarely been associated with bone marrow suppression. Leukopenia, agranulocytosis, thrombocytopenia, anemia, eosinophilia, purpura, and pancytopenia have been reported with some TCAs. Patients with preexisting bone marrow suppression or blood dyscrasias receiving TCAs should be monitored closely during therapy for further decreases in blood counts.

References

  1. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  2. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. Hunt KA, Resnick MP "Clomipramine-induced agranulocytosis and its treatment with G-CSF." Am J Psychiatry 150 (1993): 522-3
  4. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  5. Magni G, Urbani A, Silvestro A, Grassetto M "Clomipramine-induced pancytopenia." J Nerv Ment Dis 175 (1987): 309-10
  6. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  7. Albertini RS, Penders TM "Agranulocytosis associated with tricyclics." J Clin Psychiatry 39 (1978): 483-5
  8. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  9. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  10. Souhami RL, Ashton CR, Lee-Potter JP "Agranulocytosis and systemic candidiasis following clomipramine therapy." Postgrad Med J 52 (1976): 472-4
  11. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  12. Wolf B, Conradty M, Grohmann R, Ruther E, Witzgall H, Londong V "A case of immune complex hemolytic anemia, thrombocytopenia, and acute renal failure associated with doxepin use." J Clin Psychiatry 50 (1989): 99-100
  13. Gravenor DS, Leclerc JR, Blake G "Tricyclic antidepressant agranulocytosis." Can J Psychiatry 31 (1986): 661
  14. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  15. Draper BM, Manoharan A "Neutropenia with cross-intolerance between two tricyclic antidepressant agents." Med J Aust 146 (1987): 452-3
  16. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 16 references
Moderate

Tcas (Includes Etrafon) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Both elevation and lowering of blood sugar levels have been reported with the use of some tricyclic antidepressants (TCAs). Rarely, these effects have also occurred with maprotiline, a tetracyclic antidepressant. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents, particularly during dosage escalation or whenever dosage has been altered.

References

  1. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  3. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  5. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  6. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  7. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  8. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  9. Zogno MG, Tolfo L, Draghi E "Hypoglycemia caused by maprotiline in a patient taking oral antidiabetics." Ann Pharmacother 28 (1994): 406
  10. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  11. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
View all 11 references
Moderate

Tcas (Includes Etrafon) ↔ Renal/Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

References

  1. Gram LF, Andreasen PB, Overo KF, Christiansen J "Comparison of single dose kinetics of imipramine, nortriptyline and antipyrine in man." Psychopharmacology (Berl) 50 (1976): 21-7
  2. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  3. Nelson JC, Jatlow PI "Nonlinear desipramine kinetics: prevalence and importance." Clin Pharmacol Ther 41 (1987): 666-70
  4. Brosen K, Gram LF "First-pass metabolism of imipramine and desipramine: impact of the sparteine oxidation phenotype." Clin Pharmacol Ther 43 (1988): 400-6
  5. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. Virtanen R, Scheinin M, Iisalo E "Single dose pharmacokinetics of doxepin in healthy volunteers." Acta Pharmacol Toxicol (Copenh) 47 (1980): 371-6
  7. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  8. Ziegler VE, Biggs JT, Wylie LT, Rosen SH, Hawf DJ, Coryell WH "Doxepin kinetics." Clin Pharmacol Ther 23 (1978): 573-9
  9. Linnoila M, Insel T, Kilts C, Potter WZ, Murphy DL "Plasma steady-state concentrations of hydroxylated metabolites of clomipramine." Clin Pharmacol Ther 32 (1982): 208-11
  10. Sandoz M, Vandel S, Vandel B, et al "Metabolism of amitriptyline in patients with chronic renal failure." Eur J Clin Pharmacol 26 (1984): 227-32
  11. Jorgensen A, Hansen V "Pharmacokinetics of amitriptyline infused intravenously in man." Eur J Clin Pharmacol 10 (1976): 337-41
  12. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  13. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  14. Lieberman JA, Cooper TB, Suckow RF, et al "Tricyclic antidepressant and metabolite levels in chronic renal failure." Clin Pharmacol Ther 37 (1985): 301-7
  15. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  16. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  17. Schulz P, Turner-Tamiyasu K, Smith G, Giacomini KM, Blaschke TF "Amitriptyline disposition in young and elderly normal men." Clin Pharmacol Ther 33 (1983): 360-6
  18. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  19. Dawling S, Crome P, Braithwaite R "Pharmacokinetics of single oral doses of nortriptyline in depressed elderly hospital patients and young healthy volunteers." Clin Pharmacokinet 5 (1980): 394-401
  20. Dawlilng S, Lynn K, Rosser R, Braithwaite R "The pharmacokinetics of nortriptyline in patients with chronic renal failure." Br J Clin Pharmacol 12 (1981): 39-45
  21. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  22. Henry JF, Altamura C, Gomeni R, Hervy MP, Forette F, Morselli PL "Pharmacokinetics of amitriptyline in the elderly." Int J Clin Pharmacol Ther Toxicol 19 (1981): 1-5
  23. Faulkner RD, Pitts WM, Lee CS, Lewis WA, Fann WE "Multiple-dose doxepin kinetics in depressed patients." Clin Pharmacol Ther 34 (1983): 509-15
  24. Alexanderson B "Pharmacokinetics of nortriptyline in man after single and multiple oral doses: the predictability of steady-state plasma concentrations from single-dose plasma-level data." Eur J Clin Pharmacol 4 (1972): 82-91
  25. Ciraulo DA, Barnhill JG, Jaffe JH "Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers." Clin Pharmacol Ther 43 (1988): 509-18
  26. Midha KK, Hubbard JW, McKay G, et al "Stereoselective pharmacokinetics of doxepin isomers." Eur J Clin Pharmacol 42 (1992): 539-44
  27. Gram LF, Overo KF "First-pass metabolism of nortriptyline in man." Clin Pharmacol Ther 18 (1975): 305-14
View all 27 references
Moderate

Tcas (Includes Etrafon) ↔ Schizophrenia/Bipolar Disorder

Moderate Potential Hazard, Moderate plausibility

Applies to: Schizophrenia, Bipolar Disorder, Mania

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

References

  1. Vallada HP, Gentil V "Musical hallucinations triggered by clomipramine?" Br J Psychiatry 159 (1991): 888-9
  2. Holmes VF, Fricchione GL "Hypomania in an AIDS patient receiving amitriptyline for neuropathic pain." Neurology 39 (1989): 305
  3. Hemmingsen R, Rafaelsen OJ "Hypnagogic and hypnopompic hallucinations during amitriptyline treatment." Acta Psychiatr Scand 62 (1980): 364-8
  4. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  5. Cruz R "Clomipramine side effects." J Am Acad Child Adolesc Psychiatry 31 (1992): 1168-9
  6. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  7. Kupfer DJ, Carpenter LL, Frank E "Possible role of antidepressants in precipitating mania and hypomania in recurrent depression." Am J Psychiatry 145 (1988): 804-8
  8. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  9. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  10. Rampling D "Aggression: a paradoxical response to tricyclic antidepressants." Am J Psychiatry 135 (1978): 117-8
  11. "Product Information. Asendin (amoxapine)" Lederle Laboratories, Wayne, NJ.
  12. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  13. Hardoby W "Imipramine and suicidal thoughts ." Am J Psychiatry 149 (1992): 412-3
  14. Preskorn SH, Simpson S "Tricyclic-antidepressant-induced delirium and plasma drug concentration." Am J Psychiatry 139 (1982): 822-3
  15. Godwin CD "Case report of tricyclic-induced delirium at a therapeutic drug concentration." Am J Psychiatry 140 (1983): 1517-8
  16. van Kammen DP, van Scheyen JD, Murphy DL "Platelet monoamine oxidase activity and clomipramine-induced mania in unipolar depressed patients." Biol Psychiatry 15 (1980): 565-73
  17. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  18. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  19. Norman TR, Judd F, Holwill BJ, Burrows GD "Doxepin and visual hallucinations." Aust N Z J Psychiatry 16 (1982): 295-6
  20. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  21. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  22. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  23. Peet M "Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants." Br J Psychiatry 164 (1994): 549-50
  24. Harper G "Suicidality with clomipramine." J Am Acad Child Adolesc Psychiatry 31 (1992): 369-70
View all 24 references
Moderate

Tcas (Includes Etrafon) ↔ Tardive Dyskinesia

Moderate Potential Hazard, Moderate plausibility

Applies to: Tardive Dyskinesia

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. As with other drugs that possess anticholinergic activity, TCAs may aggravate tardive dyskinesia or induce previously suppressed symptoms. Patients with tardive dyskinesia requiring therapy with TCAs should be monitored for exacerbation of the condition.

References

  1. "Product Information. Vivactil (protriptyline)" Merck & Co, Inc, West Point, PA.
  2. "Product Information. Pamelor (nortriptyline)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. Lee HK "Dystonic reactions to amitriptyline and doxepin ." Am J Psychiatry 145 (1988): 649
  4. Schatzberg AF, Cole JO, Blumer DP "Speech blockage: a tricyclic side effect." Am J Psychiatry 135 (1978): 600-1
  5. Nelson JC, Jatlow PI, Bock J, Quinlan DM, Bowes MB "Major adverse reactions during desipramine treatment." Arch Gen Psychiatry 39 (1982): 1055-61
  6. Dekret JJ, Maany I, Ramsey TA, Mendels J "A case of oral dyskinesia associated with imipramine treatment." Am J Psychiatry 134 (1977): 1297-8
  7. Woogen S, Graham J, Angrist B "A tardive dyskinesia-like syndrome after amitriptyline treatment." J Clin Psychopharmacol 1 (1981): 34-6
  8. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
  9. "Product Information. Tofranil (imipramine)." Novartis Pharmaceuticals, East Hanover, NJ.
  10. "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Sinequan (doxepin)." Roerig Division, New York, NY.
  12. "Product Information. Ludiomil (maprotiline)." Ciba-Geigy Pharmaceuticals, East Hanover, NJ.
  13. Finder E, Lin K-M, Ananth J "Dystonic reaction to amitriptyline." Am J Psychiatry 139 (1982): 1220
  14. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  15. "Product Information. Surmontil (trimipramine)" Wyeth-Ayerst Laboratories, Philadelphia, PA.
  16. Sandyk R "Persistent akathisia associated with early dyskinesia." Postgrad Med J 60 (1984): 916
  17. Gersten SP "Tardive dyskinesia-like syndromes with clomipramine ." Am J Psychiatry 150 (1993): 165-6
  18. "Product Information. Norpramin (desipramine)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 18 references
Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Acute Alcohol Intoxication

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism

Tricyclic antidepressants can enhance the response to alcohol. In patients who may use alcohol excessively, it should be borne in mind that the potentiation may increase the danger inherent in any suicide attempt or overdosage.

Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Bipolar Disorder Screening

Moderate Potential Hazard, Moderate plausibility

Applies to: Bipolar Disorder

A major depressive episode can be the initial presentation of bipolar disorder. Patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating treatment with a tricyclic antidepressant. This screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that tricyclic antidepressants are not approved for use in treating bipolar depression.

Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma (Narrow Angle)

Tricyclic antidepressants as other type of antidepressants have an effect on pupil size causing dilation. This effect can potentially narrow the eye angle resulting in increased intraocular pressure and angle closure glaucoma, especially in predisposed patients. These drugs should be used with caution in patients with anatomically narrow angle or history of glaucoma. Doxepin hydrochloride capsules are contraindicated in patients with glaucoma.

Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Hyper/Hypoglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Hypoglycemia

There have been reports of both elevation and lowering of blood sugar levels in patients receiving tricyclic antidepressants. These drugs should be used with caution in patients with hypoglycemia, hyperglycemia or diabetes. Monitoring sugar levels is recommended.

Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Liver/Renal Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction, Liver Disease

In general, tricyclic antidepressants should be used with caution in patients with liver or renal disease, as these drugs are metabolized and excreted through the liver and kidneys. Dose selection, especially in the elderly patients that might have liver or renal dysfunction, should usually be limited to the smallest effective total daily dose. Some tricyclic antidepressants such as clomipramine and nortriptyline have occasionally been associated with elevations in SGOT (AST) and SGPT (ALT), and other hepatic adverse events such as jaundice. Although serious liver injury has only been reported rarely, therapy with these drugs should be administered cautiously in patients with preexisting liver disease and periodic monitoring of liver enzyme levels is recommended.

References

  1. Larrey D, Rueff B, Pessayre D, Danan G, Algard M, Geneve J, Benhamou JP "Cross hepatotoxicity between tricyclic antidepressants." Gut 27 (1986): 726-7
  2. "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals, Summit, NJ.
Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Neutropenia

Moderate Potential Hazard, Moderate plausibility

Applies to: Neutropenia

The use of some tricyclic antidepressants has been associated with neutropenia (ANC < 500/mm3) and agranulocytosis (ANC < 500/mm3). Leukocyte and differential blood counts should be performed in patients that develop fever and sore throat during treatment. Therapy should be discontinued if there is evidence of pathologic neutrophil depression.

Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Schizophrenia

Moderate Potential Hazard, Moderate plausibility

Applies to: Schizophrenia

Some tricyclic antidepressants have shown to cause activation or exacerbation of psychosis in schizophrenic patients. A dosage reduction might be required.

Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Thyroid Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperthyroidism

Most tricyclic antidepressants should be administered with caution in hyperthyroid patients or those receiving thyroid medication as they may develop arrhythmias when these drugs are given.

Moderate

Tricyclic Antidepressants (Includes Etrafon) ↔ Urinary Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention

Due to their anticholinergic properties, tricyclic antidepressants should be administered with caution in patients with history of urinary retention. Particularly doxepin hydrochloride capsules are contraindicated in patients with tendency to urinary retention.

Etrafon (amitriptyline / perphenazine) drug Interactions

There are 1279 drug interactions with Etrafon (amitriptyline / perphenazine)

Etrafon (amitriptyline / perphenazine) alcohol/food Interactions

There is 1 alcohol/food interaction with Etrafon (amitriptyline / perphenazine)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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