Introduction

Amitriptyline/perphenazine (Duo-Vil, Etrafon, Triavil, Triptafen) is a formulation that contains the tricyclic antidepressant amitriptyline and the medium-potency typical (first-generation) antipsychotic, perphenazine. In the United States amitriptyline/perphenazine is marketed by Mylan Pharmaceuticals Inc. and Remedy Repack Inc.

Medical Uses

In the United States amitriptyline/perphenazine is indicated for the treatment of patients with:

• Moderate-severe anxiety and/or agitation and depression
• Depression and anxiety in association with chronic physical disease
• Schizophrenia with prominent depressive symptoms

Adverse Effects

Common (>1% incidence) Adverse Effects Include

• Sedation
• Hypertension — high blood pressure.
• Neurological impairments (such as extrapyramidal side effects which include dystonia, akathisia, parkinsonism, muscle rigidity, etc.)
• Anticholinergic side effects such as:
  • Blurred vision
  • Constipation
  • Dry mouth
  • Nasal congestion
• Increased appetite
• Weight gain
• Nausea
• Dizziness
• Headache
• Vomiting

Unknown Frequency Adverse Effects Include

• Diarrhoea
• Alopecia — hair loss
• Photophobia
• Pigmentation
• Eczema up to exfoliative dermatitis
• Urticaria
• Erythema
• Itching
• Photosensitivity (increased sensitivity of affected skin to sunlight)
• Hypersalivation — excessive salivation.
• Hyperprolactinaemia — elevated blood prolactin levels. This may present with the following symptoms:
  • Galactorrhoea — the release of milk that is not associated with pregnancy or breastfeeding
  • Gynaecomastia — the development of breast tissue in males
  • Disturbances in menstrual cycle
  • Sexual dysfunction
• Pigmentation of the cornea and lens
• Hyperglycaemia — elevated blood glucose (sugar) levels.
• Hypoglycaemia — low blood glucose (sugar) levels.
• Disturbed concentration
• Excitement
• Anxiety
• Insomnia
• Restlessness
• Nightmares
• Weakness
• Fatigue
• Diaphoresis — excessive/abnormal sweating.

Uncommon/Rare Adverse Effects Include

• Tardive dyskinesia, an often irreversible adverse effect that usually results from chronic use antipsychotic medications, especially the high-potency first-generation antipsychotics. It is characterised by slow (hence tardive), involuntary, repetitive, purposeless muscle movements.
• Neuroleptic malignant syndrome, a potentially fatal complication of antipsychotic drug use. It is characterised by the following symptoms:
  • Muscle rigidity
  • Tremors
  • Mental status change (e.g. hallucinations, agitation, stupor, confusion, etc.)
  • Hyperthermia — elevated body temperature
  • Autonomic instability (e.g. tachycardia, high blood pressure, diaphoresis, diarrhoea, etc.)
• Urinary retention — the inability to pass urine despite having urine to pass.
• Blood dyscrasias e.g. agranulocytosis (a potentially fatal drop in white blood cell count), leukopenia (a drop in white blood cell counts but not to as extreme an extent as agranulocytosis), neutropoenia (a drop in neutrophil [the cells of the immune system that specifically destroy bacteria] count), thrombocytopaenia (a dangerous drop in platelet [a cell found in the blood that plays a crucial role in the blood clotting process] counts), purpura (the appearance of red or purple discolouration’s of the skin that do not blanch when pressure is applied), eosinophilia (raised eosinophil [the cells of the immune system that specifically fights off parasites] count)
• Hepatitis — inflammation of the liver
• Jaundice
• Pigmentary retinopathy
• Anaphylactoid reactions
• Oedema — the abnormal build-up of fluids in the tissues
• Asthma
• Coma
• Seizures
• Confusional states
• Disorientation
• Incoordination
• Ataxia
• Tremors
• Peripheral neuropathy — nerve damage
• Numbness, tingling and paraesthesia of the extremities
• Dysarthria
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Tinnitus — falsely hearing ringing in the ears.
• Alteration in EEG patterns
• Paralytic ileus — cessation of the peristaltic waves that propel partially digested food through the digestive tract.
• Hyperpyrexia (elevated body temperature)
• Disturbance of accommodation
• Increased intraocular pressure
• Mydriasis

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