Amitriptyline/perphenazine (Duo-Vil, Etrafon, Triavil, Triptafen) is a formulation that contains the

tricyclic antidepressant Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants, which is important for the management of depression. They are second-line drugs next to SSRIs. TCAs were discovered in the early 1950s and wer ...

amitriptyline Amitriptyline, sold under the brand name Elavil among others, is a tricyclic antidepressant primarily used to treat cyclic vomiting syndrome (CVS), major depressive disorder and a variety of pain syndromes from neuropathic pain to fibromyalgi ...

and the medium-potency typical (first-generation) antipsychotic,

perphenazine Perphenazine is a typical antipsychotic drug. Chemically, it is classified as a piperazinyl phenothiazine. Originally marketed in the United States as Trilafon, it has been in clinical use for decades. Perphenazine is roughly ten times as pote ...

. In the United States amitriptyline/perphenazine is marketed by Mylan Pharmaceuticals Inc. and Remedy Repack Inc.

Medical uses

In the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...

amitriptyline/perphenazine is indicated for the treatment of patients with:amitriptyline/perphenazine (Rx) - Etrafon, Triptafen, Triavil nternet Medscape Reference. ited 2013 Oct 7 Available from: http://reference.medscape.com/drug/etrafon-triptafen-amitriptyline-perphenazine-342946 * Moderate-severe

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

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:Truven Health Analytics, Inc. DRUGDEX® System (Internet) ited 2013 Oct 7 Greenwood Village, CO: Thomsen Healthcare; 2013. * Sedation * Hypertension — high blood pressure. * Neurological impairments (such as extrapyramidal side effects which include dystonia,

akathisia Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still. Usually, the legs are most prominently affected. Those affected may fidget, rock back a ...

parkinsonism Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia (slowed movements), rigidity, and postural instability. These are the four motor symptoms found in Parkinson's disease (PD), after which it is named, dementia with Lewy b ...

, 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: :- Galactorrhea — 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 Tardive dyskinesia (TD) is a disorder that results in involuntary repetitive body movements, which may include grimacing, sticking out the tongue or smacking the lips. Additionally, there may be rapid jerking movements or slow writhing movemen ...

, 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 Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fa ...

, 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 Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladd ...

— the inability to pass urine despite having urine to pass. * Blood dyscrasias e.g. agranulocytosis (a potentially fatal drop in white blood cell count), leukopaenia (a drop in white blood cell counts but not to as extreme an extent as agranulocytosis), neutropaenia (a drop in neutrophil he cells of the immune system that specifically destroy bacteriacount),

thrombocytopaenia Thrombocytopenia is a condition characterized by abnormally low levels of platelets, also known as thrombocytes, in the blood. It is the most common coagulation disorder among intensive care patients and is seen in a fifth of medical patients an ...

(a dangerous drop in platelet cell found in the blood that plays a crucial role in the blood clotting processcounts),

purpura Purpura () is a condition of red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, ...

(the appearance of red or purple discolourations of the skin that do not blanch when pressure is applied), eosinophilia (raised eosinophil he cells of the immune system that specifically fights off parasitescount) * Hepatitis — inflammation of the liver * Jaundice * Pigmentary retinopathy * Anaphylactoid reactions * Oedema — the abnormal buildup of fluids in the tissues * Asthma * Coma * Seizures * Confusional states * Disorientation * Incoordination * Ataxia * Tremors * Peripheral neuropathy — nerve damage * Numbness, tingling and paresthesias of the extremities *

Dysarthria Dysarthria is a speech sound disorder resulting from neurological injury of the motor component of the motor–speech system and is characterized by poor articulation of phonemes. In other words, it is a condition in which problems effectively ...

Syndrome of inappropriate antidiuretic hormone secretion Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive unsuppressible release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an abnormal non-pituitary source. Unsuppressed ADH ca ...

(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

Pharmacology

Binding affinities (K_i M for human cloned receptors when available)National Institute of Mental Health. PDSD Ki Database (Internet) ited 2013 Oct 7 Chapel Hill (NC): University of North Carolina. 1998-2013. Available from:

References

{{Tricyclics Muscarinic antagonists Tricyclic antidepressants Typical antipsychotics Combination psychiatric drugs

Medical uses

Adverse effects

Pharmacology

See also

References