Perphenazine

IMPORTANT WARNING:

Studies have shown that older adults with dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and that may cause changes in mood and personality) who take antipsychotics (medications for mental illness) such as perphenazine have an increased chance of death during treatment.

Perphenazine is not approved by the Food and Drug Administration (FDA) for the treatment of behavior problems in older adults with dementia. Talk to the doctor who prescribed this medication if you, a family member, or someone you care for has dementia and is taking perphenazine. For more information, visit the FDA website: http://www.fda.gov/Drugs

WHY is this medicine prescribed?

Perphenazine is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions). Perphenazine is also used to control severe nausea and vomiting in adults. Perphenazine is in a class of medications called conventional antipsychotics. It works by decreasing abnormal excitement in the brain.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Perphenazine comes as a tablet to take by mouth. It is usually taken two to four times a day. Take perphenazine at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take perphenazine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on an average dose of perphenazine and decrease your dose once your symptoms are controlled. Be sure to tell your doctor how you are feeling during your treatment with perphenazine.

Perphenazine may help to control your symptoms but will not cure your condition. Continue to take perphenazine even if you feel well. Do not stop taking perphenazine without talking to your doctor. If you suddenly stop taking perphenazine, you may experience withdrawal symptoms such as nausea, vomiting, stomach pain, dizziness, and shakiness. Your doctor will probably decrease your dose gradually and may prescribe other medication(s) for you to take for several weeks after you stop taking perphenazine.

What SPECIAL PRECAUTIONS should I follow?

Before taking perphenazine,

• tell your doctor and pharmacist if you are allergic to perphenazine; other phenothiazines such as chlorpromazine, fluphenazine, prochlorperazine (Compazine), promethazine (Phenergan), thioridazine, or trifluoperazine;or any other medications.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); antidepressants; antihistamines; atropine (in Motofen, in Lomotil, in Lonox); barbiturates such as pentobarbital (Nembutal), phenobarbital (Luminal), and secobarbital (Seconal); bupropion (Aplenzin, Wellbutrin, Zyban); chlorpheniramine (in cough and cold medications); cimetidine (Tagamet); clomipramine (Anafranil); duloxetine (Cymbalta); epinephrine (Epipen); haloperidol (Haldol); ipratropium (Atrovent); medications for anxiety or mental illness, irritable bowel disease, motion sickness, Parkinson's disease, seizures, ulcers, or urinary problems; methadone (Dolophine); narcotic medications for pain; quinidine; ritonavir (Norvir, in Kaletra); sedatives; certain selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft); sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have or have ever had brain damage, any condition that affects your blood cells, including conditions that affect the production of blood cells by your bone marrow, trouble keeping your balance, or liver disease. Your doctor may tell you not to take perphenazine.

• tell your doctor if you have or have ever had pheochromocytoma (tumor on a small gland near the kidneys); breast cancer; seizures; an abnormal electroencephalogram (EEG; test that measures the electrical activity in the brain); depression; conditions that affect your breathing such as asthma, emphysema, or a lung infection; or heart or kidney disease. Also tell your doctor if you are experiencing alcohol withdrawal (symptoms that a person may experience if he/she stops drinking alcohol after drinking heavily for a long time), if you have ever had to stop taking a medication for mental illness due to severe side effects, or if you plan to work with organophosphate insecticides (a type of chemical used to kill insects).

• if you will be using perphenazine to treat nausea and vomiting, it is important to tell your doctor about any other symptoms you are experiencing, especially listlessness; drowsiness; confusion; aggression; seizures;headaches; problems with vision, hearing, speech, or balance; stomach pain or cramps; or constipation. Nausea and vomiting that is experienced along with these symptoms may be a sign of a more serious condition that should not be treated with perphenazine.

• tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breast-feeding. If you become pregnant while taking perphenazine, call your doctor. Perphenazine may cause problems in newborns following delivery if it is taken during the last months of pregnancy.

• you should know that this medication may make you drowsy and may affect your thinking and movements. Do not drive a car or operate machinery until you know how this medication affects you.

• ask your doctor about the safe use of alcohol while you are taking this medication. Alcohol can make the side effects of perphenazine worse.

• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Perphenazine may make your skin sensitive to sunlight.

• you should know that perphenazine may make it more difficult for your body to cool down when it gets very hot. Tell your doctor if you plan to do vigorous exercise or be exposed to extreme heat.

• you should know that perphenazine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking perphenazine. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Perphenazine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness, feeling unsteady, or having trouble keeping your balance
• blurred vision
• widening or narrowing of the pupils (black circles in the middle of the eyes)
• pale skin
• dry mouth
• excess saliva
• stuffed nose
• headache
• nausea
• vomiting
• diarrhea
• constipation
• loss of appetite
• blank facial expression
• shuffling walk
• unusual, slowed, or uncontrollable movements of any part of the body
• restlessness
• difficulty falling asleep or staying asleep
• unusual dreams
• falsely feeling threatened by others
• difficult or frequent urination
• inability to control urination
• change in skin color
• breast enlargement
• breast milk production
• missed menstrual periods
• decreased sexual ability in men

Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:

• fever
• muscle stiffness
• falling
• confusion
• fast or irregular heartbeat
• sweating
• decreased thirst
• neck cramps
• tongue that sticks out of the mouth
• tightness in the throat
• difficulty breathing or swallowing
• fine, worm-like tongue movements
• uncontrollable, rhythmic face, mouth, or jaw movements
• seizures
• eye pain or discoloration
• vision loss, especially at night
• seeing everything with a brown tint
• yellowing of the skin or eyes
• rash
• hives
• itching
• swelling of the eyes, face, mouth, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
• difficulty breathing or swallowing
• slowed heartbeat
• sore throat, fever, chills, and other signs of infection

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Perphenazine may cause other side effects. Tell your doctor if you have any unusual problems while you are taking this medication.

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• difficulty responding to surroundings
• coma (loss of consciousness for a period of time)
• seizures
• fast or irregular heartbeat

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to perphenazine.

Perphenazine may interfere with the results of home pregnancy tests. Tell your doctor if you think you might be pregnant during your treatment with perphenazine. Do not try to test for pregnancy at home.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

^¶ This branded product is no longer on the market. Generic alternatives may be available.