Dosing and uses of Trilafon (perphenazine)
Adult dosage forms and strengths
tablets
- 2mg
- 4mg
- 8mg
- 16mg
Intractable Hiccoughs
8-16 mg PO qDay divided q8-12hr
Maximum: 24 mg
Treatment of Nausea/Vomiting
8-16 mg PO qDay divided q6-12hr
Maximum: 24 mg
Schizophrenia
Hospitalized patients: 8-16mg PO q6-12hr
Hospitalized patients: Not to exceed 64 mg/day divided q6-12hr
Outpatients: 4-8mg PO q8hr; reduce as soon as possible to minimum effective dose
Hepatic Impairment
Dose adjustment not described in manufacturer's labeling
Renal Impairment
Dose adjustment not described in manufacturer's labeling
Pediatric dosage forms and strengths
tablets
- 2mg
- 4mg
- 8mg
- 16mg
Intractable Hiccoughs
<12 years
- Not recommended by manufacturer
>12 years
- 8-16 mg PO qDay divided q8-12hr Maximum: 24 mg
Schizophrenia
<12 years
- Not recommended by manufacturer
>12 years
- Hospitalized patients: 8-16mg PO q6-12hr
- Hospitalized patients: Not to exceed 64 mg/day divided q6-12hr
- Outpatients: 4-8mg PO q8hr; reduce as soon as possible to minimum effective dose
Geriatric dosage forms and strengths
Initiate dosing at lower end of the range
Intractable Hiccoughs
8-16 mg PO qDay divided q8-12hr
Maximum: 24 mg
Treatment of Nausea/Vomiting
8-16 mg PO qDay divided q6-12hr
Maximum: 24 mg
Schizophrenia
Hospitalized patients: 8-16mg PO q6-12hr
Hospitalized patients: Not to exceed 64 mg/day divided q6-12hr
Outpatients: 4-8mg PO q8hr; reduce as soon as possible to minimum effective dose
Trilafon (perphenazine) adverse (side) effects
>10%
Akathisia (60%)
Frequency not defined
Confusion
Decreased gag reflex
EPs
- Akathisia (60%)
- Dystonia
- Muscle stiffness
- Neuroleptic malignant syndrome (infrequent but serious)
- Parkinsonism
- Tardive dyskinesia
Common
- Anticholinergic effects
- Sedation
- Weight gain
- Oligomenorrhea/amenorrhea
- Erectile dysfunction
Less Common
- Orthostatic hypotension (post-IM inj), tachycardia
- Anxiety, agitation, cerebral edema, depression, dizziness, euphoria, headache, insomnia, restless, weakness
- Anorexia, dyspepsia, constipation, ileus
- Lens opacities (prolonged use)
Uncommon
- ECG changes
- Photosensitivity
- Pruritis
- Galactorrhea
- Ejaculatory disorder
- Diarrhea
- Blood dyscrasia
Rare
- Seizure
- Priapism
- Cholestatic jaundice
Warnings
Black box warnings
Patients with dementia-related psychosis who are treated with antipsychotic drugs are at an increased risk of death as shown in short-term controlled trials. The deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature
This drug is not approved for the treatment of patients with dementia-related psychosis
Contraindications
Documented hypersensitivity to phenothiazines
Coma, severe hypotension, severe CNS depression, concurrency with large amounts of CNS depressants, poorly controlled seizure disorder, subcortical brain damage, myelosuppression, liver damage, blood dyscrasias
Severe cardiovascular disease
Lactation
Cautions
Avoid using in children with suspected Reye's syndrome
Glaucoma, prostatic hypertrophy, stenosing PUD, tardive dyskinesia, history of NMS, Parkinson's disease, hypocalcemia, renal/hepatic impairment, patients who have exhibited a severe reaction to insulin or ECT, history of seizures, asthma, respiratory tract infections, cardiovascular disease
Hypotension may be particularly severe in patients with pheochromocytoma or mitral insufficiency
Depresses hypothalamic thermoregulatory mechanism; exposure to extreme temperatures may cause hypo- or hyperthermia
In case of severe hypotension, use norepinephrine or phenylepinephrine, do NOT use epinephrine or dopamine
Antiemetic effect may obscure toxicity of chemotherapeutic drugs
May need anticholinergic antiparkinsonian agent to counter EPs
FDA Warning regarding off-label use for dementia in elderly
Pregnancy and lactation
Pregnancy category: C
Lactation: avoid
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Trilafon (perphenazine)
Mechanism of action
Antipsychotic that blocks postsynaptic mesolimbic dopaminergic receptors in the brain; it has moderate anticholinergic effects, weak to moderate sedative effects, strong extrapyramidal effects, and strong antiemetic activity
Pharmacokinetics
Peak Plasma Time: 1-3 hr; 2-4 hr (metabolite)
Half-Life: 9-12 hr (; 10-19 hr (metabolite)
Concentration: 984 pg/mL; 509 pg/mL (metabolite)
Metabolism: Hepatic P450 enzyme CYP2D6
Metabolites: 7-hydroxyperphenazine
Enzymes inhibited: CYP2D6
Excretion: Urine and feces
