PERPHENAZINE & AMITRIPTYLINE

Brand & Generic Names

Elavil Plus
Etrafon
PMS Levazine
Proavil
Triamed
Triavil

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes
• Drug class: Tranquilizer (phenothiazine), antidepressant

Uses

• Decreases nausea, vomiting, hiccups.
• Gradually relieves, but doesn't cure, symptoms of depression, anxiety, agitation.
• Pain relief (sometimes).

Dosage & Usage Information

How to take:
Tablet or liquid--Swallow with liquid.

When to take:
At the same time each day.

If you forget a dose:
Bedtime dose--If you forget your once-a- day bedtime dose, don't take it more than 3 hours late. If more than 3 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Suppresses brain's vomiting center.
Suppresses brain centers that control abnormal emotions and behavior.
Probably affects part of brain that controls messages between nerve cells.

Time lapse before drug works:
Nausea and vomiting--1 hour or less.
Nervous and mental disorders--4-6 weeks.
Begins in 1 to 2 weeks. May require 4 to 6 weeks for maximum benefit.

Don't take with:
Antacid or medicine for diarrhea.
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Stupor, convulsions, hallucinations, coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• If patient is unconscious and not breathing, give mouth-to- mouth breathing. If there is no heartbeat, use cardiac massage and mouth-to-mouth breathing (CPR). Don't try to make patient vomit. If you can't get help quickly, take patient to nearest emergency facility.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

Seizures; irregular Discontinue. Seek heartbeat; weak pulse; emergency treatment. fainting; muscle spasms; uncontrolled muscle movements of tongue, face and other muscles (neuroleptic malignant syndrome*).

Common:

• Headache, nausea, vomiting, irregular heartbeat, drowsiness.
• Insomnia, dry mouth, "sweet tooth," decreased sweating, runny nose, constipation.

Infrequent:

• Hallucinations, dizziness, tremor, blurred vision, eye pain, inflamed tongue, joint pain, back pain, hiccups.
• Frequent urination, diminished sex drive, breast swelling, menstrual irregularities, nasal congestion.

Rare:

• Rash; itchy skin; jaundice; change in vision; sore throat, fever, mouth sores; abdominal pain.
• Fatigue, weakness.

Warnings & Precautions

Don't take if:

• You are allergic to any phenothiazine, tricyclic antidepressant.
• You have a blood or bone-marrow disease, glaucoma, prostate trouble.
• You drink alcohol.
• You have had a heart attack within 6 weeks.
• You have taken MAO inhibitors within 2 weeks.
• Patient is younger than 12.

Before you start, consult your doctor:

• If you have asthma, emphysema or other lung disorder.
• If you have an enlarged prostate, heart disease, high blood pressure, stomach or intestinal problems, overactive thyroid, liver disease.
• If you take non-prescription ulcer medicine, asthma medicine or amphetamines.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons. More likely to develop involuntary movement of jaws, lips, tongue; chewing; difficult urination. Report this to your doctor immediately. Early treatment can help.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Drug passes into milk. Avoid drug or discontinue nursing until you finish medicine. Consult doctor for advice on maintaining milk supply.

Infants & children:
Don't give to children younger than 12.

Prolonged use:
May lead to tardive dyskinesia (involuntary movement of jaws, lips, tongue, chewing).

Skin & sunlight:
May cause rash or intensify sunburn in areas exposed to sun or sunlamp. Skin may remain sensitive for 3 months after discontinuing.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes, such as antihistamines, tranquilizers, sedatives, pain medicine, narcotics and mind-altering drugs.

Discontinuing:

• Nervous and mental disorders--Don't discontinue without doctor's advice until you complete prescribed dose, even though symptoms diminish or disappear.
• Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment.

Others:
No problems expected.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Anticholinergics*	Increased anticholinergic effect,
	increased sedation.
Anticoagulants*,	Increased anticoagulant effect.
Antihistamines*	Increased antihistamine effect.
Appetite	Decreased suppressant effect.
Barbiturates*	Decreased antidepressant effect.
	Increased sedation.
Cimetidine	Possible increased effect and
	toxicity of perphenazine and
	amitriptyline.
Clonidine	Possible decreased clonidine
	effect.
Dronabinol	Increased effect of both drugs.
Ethchlorvynol	Delirium.
Guanabenz	Possible decreased guanabenz
	effect.
Guanethidine	Decreased guanethidine effect.
Guanfacine	Possible decreased guanfacine
	effect.
Levodopa	Decreased levodopa effect.
Lithium	Possible decreased seizure
	threshold.
MAO inhibitors*	Fever, delirium, convulsions.
Methyldopa	Possible decreased methyldopa
	effect.
Methylphenidate	Possible increased antidepressant
	effect.
Mind-altering	Increased effect of mind-altering
drugs*	drugs.
Nabilone	Greater depression of central
	nervous system.
Narcotics*	Increased narcotic effect and
	dangerous sedation.
Phenothiazines*	Possible increased antidepressant
	effect.
Procainamide	Possible irregular heartbeat.
Procarbazine	Increased sedation.
Quinidine	Impaired heart function. Dangerous
	mixture.
Sedatives*	Dangerous oversedation.
Sympathomimetics*	Increased sympathomimetics effect.
Thyroid hormones*	Irregular heartbeat.
Tranquilizers*,	Increased tranquilizer
other	effect.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Beverages or medicines	Excessive intoxication.
with alcohol.	Avoid.
Coffee.	Reduces effectiveness.
Cocaine:	Excessive intoxication. Avoid.
Foods:	None expected.
Marijuana:	Excessive drowsiness. Avoid.
Tobacco:	None expected.