Perphenazine: Uses, Side Effects and Dosage

Serious warnings and precautions box

What PERPHENAZINE is used for:

PERPHENAZINE is used in adults and children (over 12 years of age) to:

• manage the symptoms of psychotic disorders.
• control nausea and vomiting

How PERPHENAZINE works:

PERPHENAZINE belongs to a class of medicines known as antipsychotics. The exact way PERPHENAZINE works is not known. However, it is thought to re-adjust the balance of certain chemicals in the brain (i.e., dopamine and serotonin) that allow communication between nerve cells.

The ingredients in PERPHENAZINE are:

Medicinal ingredient: Perphenazine

Non-medicinal ingredients: Carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, and titanium dioxide.

PERPHENAZINE comes in the following dosage form:

Tablets: 2 mg, 4 mg, 8 mg and 16 mg.

• PERPHENAZINE belongs to a group of medicines called antipsychotics. These medicines have been linked to a higher rate of death when used in elderly patients with dementia (loss of memory and other mental abilities).
• PERPHENAZINE is not to be used if you are elderly and have dementia.

Do not use PERPHENAZINE if:

• you are allergic to perphenazine, phenothiazines (a group of antipsychotic medications), or to any of the other ingredients in PERPHENAZINE.

• you are in a deep state of prolonged unconsciousness (coma) or have decreased alertness caused by certain medications or alcohol.

• you have a blood cell disorder (e.g., low levels or red or white blood cells, or platelets).
• you have bone marrow depression (a condition where the bone marrow does not make enough blood cells and platelets).
• you have or have a family history of long QT syndrome (a heart rhythm condition that causes fast, chaotic heartbeats) or develop this syndrome during your treatment with PERPHENAZINE.
• you have or have had a condition that causes you to have an abnormal heart rhythm (e.g., Torsade de Pointes, atrial fibrillation, low heart rate).

• you take any medications that affect how your heart beats. For example:

  • medicines used to treat an abnormal heart rhythm.
  • antidepressant medications known as Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., citalopram).
  • any medications that can cause an electrolyte imbalance (e.g., diuretics, also known as “water pills”).
• you have a medical condition known as pheochromocytoma (a tumor of the adrenal gland).
• you have a severe heart or blood vessel problems.
• you have liver or kidney problems.
• you have or have had brain damage.
• you are taking hypnotics (medicines used to help with sleep).
• you are at risk for urinary retention due to disorders of the urethra or prostate.
• you are at risk of having glaucoma (increased pressure in the eye).
• are taking medicines known as dopaminergics.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take PERPHENAZINE. Talk about any health conditions or problems you may have, including if you:

• are currently taking any other medications.
• have a condition that affects your heart and blood vessels.
• have or are prone to low blood pressure.
• have chest pain (angina pectoris)
• suffer from an increased pressure within the eye(s) (glaucoma).
• are addicted to alcohol. You should not take PERPHENAZINE if you are under the effects of alcohol.
• are receiving or planning to receive anesthesia (medicines used to induce sleep and prevent pain during surgery).
• have seizures, epilepsy, abnormal electrical activity in the brain or brain damage. PERPHENAZINE may make you more prone to seizures.

• are at risk for Torsade de Pointes (a heart rhythm condition). Risk factors include, but are not limited to:

  • being female.
  • being 65 years of age or older.
  • being genetically predisposed for heart rhythm conditions.
  • having a family history of sudden death in individuals less than 50 years of age.
  • having heart disease (e.g., heart attack, congestive heart failure, enlarged left ventricle of the heart, diseases affecting the electrical signals of your heart).
  • having an electrolyte imbalance (e.g., low levels of potassium, magnesium or calcium in the blood).
  • having a condition that affects the brain (e.g., brain bleed, stroke, head trauma).
  • having liver or kidney problems.
  • being known to poorly metabolize certain medicines.
  • having diabetes.
  • having poor nutrition.
  • having damage to the nerves that control automatic body functions (e.g., blood pressure, temperature control, bladder function, etc.).

• are at risk of developing blood clots. Risk factors include:

  • a family history of blood clots
  • being over the age of 65
  • smoking
  • being overweight
  • having a recent major surgery (such as hip or knee replacement)
  • not being able to move due to air travel or other reasons
  • taking oral birth control (“The Pill”)
• have had long-term treatment with PERPHENAZINE tablets and/or other antipsychotic medications.
• have Parkinson’s disease or dementia.
• have or have had breast cancer.

• have one of the following rare hereditary diseases:

  • Galactose intolerance
  • Lapp lactase deficiency
  • Glucose-galactose malabsorption

Because lactose is a non-medicinal ingredient in PERPHENAZINE.

• are a child or adolescent who has:

  • symptoms of Reye’s syndrome (a serious condition that causes swelling in the liver and brain) such as vomiting, lack of energy, change in mental states and seizures.
  • sudden fever.
• Exercise strenuously, or are dehydrated, or are exposed or will be exposed to extreme heat. PERPHENAZINE may interfere with your body’s ability to adjust to heat. Avoid becoming overheated or dehydrated (for example with vigorous exercise or exposure to extreme heat) while taking PERPHENAZINE.
• have previously had to stop taking other medicines for psychiatric problems like PERPHENAZINE (known as phenothiazines) because they have affected your blood cells or caused jaundice (yellowing of the skin and eyes).
• are pregnant, think you might be pregnant or are planning to become pregnant. PERPHENAZINE should not be used during pregnancy unless your healthcare professional considers that the benefits to you markedly outweigh the potential risks to the fetus.
• are breast-feeding or planning to breast-feed. It is not known if PERPHENAZINE can pass into your breast milk and harm a breast-fed baby.

Other warnings you should know about:

Driving and using machines: PERPHENAZINE may affect your mental and physical abilities. This may be more likely to occur when you start your treatment. Before you drive or do tasks that require special attention, wait until you know how you respond to PERPHENAZINE. You should be cautious when driving a car or operating machinery.

Testing and check-ups: Your healthcare professional may do check-ups and tests before you start taking PERPHENAZINE and regularly during your treatment. These may include:

• blood tests to monitor:

  • your blood sugar (glucose) levels;
  • your complete blood cell count. This test measures the number and quality of the red blood cells, white blood cells and platelets.
  • the health of your liver and kidneys.
  • body weight checks to monitor any changes in weight.
  • eye exams to monitor your visions and the health of your eyes.

If you are taking PERPHENAZINE for a long period of time and in high doses, your healthcare professional will monitor you more closely for side effects. They may adjust your dose if needed.

Pregnancy: You should not take PERPHENAZINE while you are pregnant or if you are planning on becoming pregnant unless you have talked to your healthcare professional about it. If you took PERPHENAZINE at any time while you were pregnant or if you took it before you became pregnant, the following symptoms may happen in your newborn baby:

• shaking,
• stiffness in their muscles and/or weakness,
• sleepiness,
• agitation,
• breathing problems, or
• difficulty feeding.

Get medical help right away if your newborn has any of these symptoms.

Taking PERPHENAZINE may also affect your pregnancy tests by producing false-positive or false-negative pregnancy results. PERPHENAZINE may also give false positive phenylketonuria (PKU) test results (a blood test given to newborns one to three days after birth).

Eye problems: PERPHENAZINE can cause eye problems such as mydriasis. Mydriasis is a condition where your pupils widen in an unusual way. This can cause a build-up of fluid and pressure in your eyes. Tell your healthcare professional right away if you experience visions changes, eye pain, redness in or around the eye.

Tardive dyskinesia (TD): Like other antipsychotic medications, PERPHENAZINE may cause potentially irreversible muscle twitching or unusual/abnormal movement of the face or tongue or other parts of your body.

Neuroleptic malignant syndrome (NMS): NMS is potentially a life-threatening condition that has been reported with the use of antipsychotic medications. Symptoms of NMS include:

• severe muscle stiffness or inflexibility with high fever,
• rapid or irregular heartbeat,
• sweating,
• state of confusion or reduced consciousness.

Call your healthcare professional right away if you start to have any of these symptoms while taking PERPHENAZINE.

Hyperprolactinemia (increased levels of prolactin): PERPHENAZINE can raise your levels of a hormone called “prolactin”. This is measured with a blood test. Symptoms may include:

• In men:

  • swelling in the breast,
  • difficulty in getting or maintaining an erection or other sexual dysfunction.

• In women:

  • discomfort in the breasts,
  • leaking of milk from the breasts (even if not pregnant),
  • missing your menstrual period or other problems with your cycle.

If you have high levels of prolactin and a condition called hypogonadism, you may be at an increased risk of breaking a bone due to osteoporosis. This occurs in both men and women.

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

Serious drug interactions:

Serious drug interactions with PERPHENAZINE include:

• medicines that can affect how your heart beats. These include, but are not limited to:

  • medicines used to treat an abnormal heart rhythm (e.g., quinidine, procainamide, disopyramide, amiodarone, sotalol, ibutilide).
  • other antipsychotic medications (e.g., droperidol, chlorpromazine, pimozide).
  • medicines used to treat depression (e.g., fluoxetine, venlafaxine, tricyclic/tetracyclic antidepressants, selective serotonin reuptake inhibitors [SSRIs] such as citalopram).
  • opioids, medicines used to relieve pain (e.g., methadone, codeine and tramadol).
  • medicines used to treat bacterial infections (e.g., erythromycin, clarithromycin, moxifloxacin).
  • pentamidine, used to treat a serious type of pneumonia (i.e., Pneumocystic carinii pneumonia).
  • medicines used to treat malaria (e.g., quinine).
  • medicines used to treat fungal infections (e.g., ketoconazole, fluconazole, itraconazole, voriconazole).
  • domperidone, used to speed up the movements of the stomach and bowel.
  • tacrolimus, used to prevent organ transplant rejection.
  • other medicines used to treat nausea and vomiting (e.g., ondansetron).
  • medicines used to treat breathing problems like asthma and lung disease (e.g., salmeterol, formoterol).
  • lithium, used to treat mood disorders.
  • medicines that can cause an electrolyte imbalance (e.g., diuretics, also known as “water pills”).

• medicines known as dopaminergics such as:

  • cabergoline and quinagolide, used to treat high levels of prolactin in the blood.

The following may also interact with PERPHENAZINE:

• alcohol. PERPHENAZINE can increase the effects of alcohol. You should not drink alcohol while taking PERPHENAZINE.
• anesthetics, medicines used during surgery.
• analgesics, medicines used to relieve pain.
• barbiturates, medicines used to relax the body and help with sleeping.
• medicines used to control seizures (e.g., phenytoin).
• antihistamines, medicines used to treat allergies and may cause drowsiness (e.g., diphenhydramine).
• muscle relaxants, medicines used to treat muscle spasms and back pain (e.g., dantrolene).
• sedatives and tranquilizers, medicines used to treat anxiety and/or insomnia.cisapride, used to treat gastric reflux (the regurgitation of stomach acid into the esophagus).
• medicines that may make you sleepy or drowsy (e.g., cough-and-cold medicines and sleeping pills). You should not take PERPHENAZINE if you have drowsiness caused by other medicines.
• atropine, used to treat eye problems, a low heart rate, insecticide or mushroom poisoning, or reduce saliva and fluid in the respiratory tract during surgery.
• phosphorus insecticides used for farming, treating animals (e.g., flea and tick control), and treating pests around the house or garden. PERPHENAZINE can increase the toxicity from these types of insecticides, so caution must be taken when using these products.
• medicines used treat high blood pressure and certain heart conditions (e.g., propranolol, guanethidine, guanadrel).
• oral anticoagulants, medicines used to prevent and treat blood clots (e.g., warfarin).
• antacids, used to treat indigestion.
• epinephrine, used for the emergency treatment of severe allergic reactions.
• medicines used to treat gastrointestinal problems, such as magnesium, aluminum and calcium salts, oxides and hydroxides.
• hormonal birth control.
• betel nut (also known as areca nut).

How to take PERPHENAZINE:

• Take PERPHENAZINE exactly as your healthcare professional has told you.

• Your healthcare professional will decide on the best dose for you depending on:

  • the severity of your symptoms; and
  • how you respond to your treatment.
• Your healthcare professional will give you the lowest effective dose to minimize side effects.
• Do not take PERPHENAZINE more often or increase your dose without consulting your healthcare professional. Taking more than you should will not improve your condition any faster. Instead, you will increase your risk of serious side effects.
• Do not stop taking this medicine suddenly without your healthcare professional’s approval.

Usual dose:

Please note, the lower range of the adult dosages listed below may be used in children over 12 years of age.

To treat psychotic disorders:

• Moderately disturbed, non-hospitalized patients:

  Adult dosage range: 4 mg to 8 mg, three times a day. Maximum dose: 24 mg per day. Your healthcare professional will reduce your dose as early as possible.

• Hospitalized patients:

  Adult dosage range: 8 mg to 16 mg, two to four times a day. Maximum dose: 64 mg per day.

To control nausea and vomiting:

Adult dosage range: 8 mg to 16 mg daily in divided doses. 24 mg may sometimes be necessary. Your healthcare professional will reduce your dose as early as possible.

Overdose:

Symptoms of an overdose with PERPHENAZINE may include:

• involuntary movements that you cannot control,
• shaking (tremors),
• agitation,
• confusion,
• drowsiness,
• usually weak breathing,
• muscle stiffness or twitching,
• feeling restless,
• seizures,
• fever,
• low blood pressure,
• dry mouth,
• lack of normal muscle contractions in the intestines, and
• fainting.

If you think you, or a person you are caring for, have taken too much PERPHENAZINE, contact a healthcare professional, hospital emergency department, regional poison control centre or Health Canada’s toll-free number, 1-844 POISON-X (1-844-764-7669) immediately, even if there are no signs or symptoms.

Missed dose:

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your next dose as scheduled. Never take two doses at once to make up for a missed dose.

Possible side effects from using PERPHENAZINE:

These are not all the possible side effects you may have when taking PERPHENAZINE. If you experience any side effects not listed here, tell your healthcare professional.

Side effects with PERPHENAZINE may include:

• sweating,
• frequent urination or lack of bladder control,
• dizziness,
• drowsiness,
• dry mouth,
• stuffy nose
• nausea or vomiting,
• headache,
• menstrual cycle changes,
• changes in libido,
• swelling of the breasts and milk production in both men and women,
• changes in bodyweight,
• changes in appetite,
• increased thirst,
• skin colouring (pigmentation), skin rashes, itching or redness, flaky skin, eczema, skin sensitivity to light,
• increased salivation,
• constipation,
• fever,
• lack of energy,
• swelling in the hands, arms, legs or feet,
• fainting,
• trouble falling asleep and/or staying asleep,
• asthma.

Serious side effects and what to do about them

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, tell your healthcare professional.

Reporting side effects

You can report any suspected side effects associated with the use of health products to Health Canada by:

• Visiting the Web page on Adverse Reaction Reporting (canada.ca/drug-device-reporting) for information on how to report online, by mail or by fax; or
• Calling toll-free at 1-866-234-2345.

NOTE: Contact your healthcare professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.

Storage:

• Store at controlled room temperature (between 15°C to 30°C).
• Do not use after the expiry date shown on the bottle.
• Keep out of reach and sight of children.

If you want more information about PERPHENAZINE:

• Talk to your healthcare professional
• Find the full product monograph that is prepared for healthcare professionals and includes the Patient Medication Information by visiting the Health Canada Drug Product Database website (https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html); the manufacturer’s website (http://www.aapharma.ca/en/); or by calling 1-877-998-9097.

Date of Authorization: May 15, 2026