Amitriptyline and Perphenazine | Memorial Sloan Kettering Cancer
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Medication: Amitriptyline 10 Mg
Amitriptyline (Elavil) COMPLEX CHRONIC DISEASES PROGRAM Medication Handout Date: May 15, 2018 Medication: Amitriptyline 10 mg What is Amitriptyline? Amitriptyline belongs to a group of medications called tricyclic antidepressants (TCAs) that were first used to treat depression. It works by altering the levels of certain neuro- transmitters in the brain such as noradrenalin and serotonin. They have since been found to be effective for many different uses such as: pain, helping with sleep quality (but is not a sleeping pill), irritable bowel syndrome (with diarrhea), migraine prevention, and interstitial cystitis. Expected Benefit: Usually takes several weeks to notice a benefit You may not notice a benefit until you get to a dose of 25 mg Watch for possible side effects: This list of side effects is important for you to be aware of; however, it is also important to remember that not all side effects happen to all people. Many of these less serious side effects will improve over the first few days of taking the medications. If you have problems with these side effects talk with your doctor or pharmacist: Dry mouth – this is the most common side; the others are much less frequent Hangover effect – too sleepy in the morning Blurred vision Urinary retention, trouble with urination Tiredness, dizziness that is more than usual Diarrhea or constipation Stopping the medication: Do NOT stop taking this medication suddenly without asking your doctor – this medication is usually decreased slowly (at higher doses) before it is stopped completely How to use this medication: Take this medication with or without food Dosing Schedule: Start with 5 mg (½ tablet) 2 hrs before bed Increase dose according to table below Many patients can only tolerate 20 or 30 mg If you don’t have dry mouth or side effects, you can continue slowly increasing the dose to a maximum of 70 mg You can stay at a lower dose (stop increasing) if you get side effects (usually dry mouth). -
Papers and Originals
BRITISH MEDICAL JOURNAL 19 FEBRUARY 1972 463 PAPERS AND ORIGINALS Drug Interaction: Inhibitory Effect of Neuroleptics on Metabolism of Tricyclic Antidepressants in Man LARS F. GRAM, KERSTIN FREDRICSON OVERO British Medical Journal, 1972, 1, 463-465 excretion (Anders, 1971). There are relatively few reports on interaction concerning neuroleptics or tricyclic antidepressants. Summary Chlorpromazine has both stimulatory and inhibitory effects on the metabolism of hexobarbitone in Total urinary excretion of radioactivity after oral or experimental animals of a test of (Riimke and Bout, 1960-1). Furthermore, chlorpromazine intravenous administration dose '4C-imi- accelerates the metabolism pramine was measured in were tested ofmeprobamate (Kato and Vassanelli, eight patients. They 1962). Tricyclic antidepressants have been shown to inhibit the before, during, and after treatment with neuroleptics. metabolism Excretion diminished while the were of tremorine and oxotremorine in rats in vitro and patients being in vivo (Hammer and Sjoqvist, 1967). It has also been found treated with perphenazine, haloperidol, or chlorproma- that zine, not treatment. desipramine hydrochloride inhibits the metabolism of though during flupenthixol amphetamine in isolated, perfused rat liver (Dingell and Bass, Total urinary excretion of radioactivity and plasma 1969). Pretreatment levels of metabolites and were measured with phenobarbitone decreased steady-state unchanged drug plasma levels of desipramine and nortriptyline in man (Sjoqvist in five patients after a test dose of 14C-nortriptyline. Each et was before and al. 1968). These findings were later confirmed in a twin study patient tested again during perphenazine (Alexanderson et al., 1969). Forrest et treatment. In all patients perphenazine treatment caused: al. (1970) found increased (1) decrease of total urinary excretion, (2) decreased urinary excretion of chlorpromazine metabolites when patients plasma level of metabolites, and (3) increased plasma were given additional treatment with phenobarbitone. -
Schizophrenia Care Guide
August 2015 CCHCS/DHCS Care Guide: Schizophrenia SUMMARY DECISION SUPPORT PATIENT EDUCATION/SELF MANAGEMENT GOALS ALERTS Minimize frequency and severity of psychotic episodes Suicidal ideation or gestures Encourage medication adherence Abnormal movements Manage medication side effects Delusions Monitor as clinically appropriate Neuroleptic Malignant Syndrome Danger to self or others DIAGNOSTIC CRITERIA/EVALUATION (PER DSM V) 1. Rule out delirium or other medical illnesses mimicking schizophrenia (see page 5), medications or drugs of abuse causing psychosis (see page 6), other mental illness causes of psychosis, e.g., Bipolar Mania or Depression, Major Depression, PTSD, borderline personality disorder (see page 4). Ideas in patients (even odd ideas) that we disagree with can be learned and are therefore not necessarily signs of schizophrenia. Schizophrenia is a world-wide phenomenon that can occur in cultures with widely differing ideas. 2. Diagnosis is made based on the following: (Criteria A and B must be met) A. Two of the following symptoms/signs must be present over much of at least one month (unless treated), with a significant impact on social or occupational functioning, over at least a 6-month period of time: Delusions, Hallucinations, Disorganized Speech, Negative symptoms (social withdrawal, poverty of thought, etc.), severely disorganized or catatonic behavior. B. At least one of the symptoms/signs should be Delusions, Hallucinations, or Disorganized Speech. TREATMENT OPTIONS MEDICATIONS Informed consent for psychotropic -
Opipramol and Trifluoperazine in the Treatment of Anxiety and Tension
A COMPARATIVE STUDY OF TWO ANTIHISTAMINES 395 In table VI are given the results of a question directed at discovering how effective the preferred treatment was compared to any other antihistamine used. Fifteen patients only were able to give this information but the results are interesting. Discussion TABLE VI The design of this study was very simple as COMPARISON WITH PREVIOUSLY USED ANTIHISTAMINE such studies must be if they are to be completed under the conditions of a busy general practice. In a condition such as hay fever where anti- Worse As good Better Total histamines are known to be etfective and where fairly rapid symptomatic relief is needed by the 2 4 9 15* patient, we did not feel justified in including a placebo. The results of the study seem fairly *In the majority of patients the previously used clear-cut that if patients are offered the choice antihistamine was the chemically related chlor- of a plain form of this antihistamine or a long- pheniramine maleate B.P. acting form more will choose the latter. Ofthose that do so, however, only about a third find a single tablet at night completely effective, the remainder have to take one further tablet during the day. Both forms of antihistamine are effective and where a retrospective comparison can be made this effectiveness is considered greater or equal to that of previously administered anti-histamines. Summary A simple comparative study under general-practice conditions of two formulations of pheniramine is described. Sixty-one per cent of patients preferred the long-acting form of this antihistamine. -
PRODUCT MONOGRAPH ELAVIL® Amitriptyline Hydrochloride Tablets
PRODUCT MONOGRAPH ELAVIL® amitriptyline hydrochloride tablets USP 10, 25, 50 and 75 mg Antidepressant AA PHARMA INC. DATE OF PREPARATION: 1165 Creditstone Road Unit #1 August 29, 2018 Vaughan, ON L4K 4N7 Control No.: 217626 1 PRODUCT MONOGRAPH ELAVIL® amitriptyline hydrochloride tablets USP 10, 25, 50, 75 mg THERAPEUTIC CLASSIFICATION Antidepressant ACTIONS AND CLINICAL PHARMACOLOGY Amitriptyline hydrochloride is a tricyclic antidepressant with sedative properties. Its mechanism of action in man is not known. Amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. Amitriptyline has pronounced anticholinergic properties and produces EKG changes and quinidine-like effects on the heart (See ADVERSE REACTIONS). It also lowers the convulsive threshold and causes alterations in EEG and sleep patterns. Orally administered amitriptyline is readily absorbed and rapidly metabolized. Steady-state plasma concentrations vary widely and this variation may be genetically determined. Amitriptyline is primarily excreted in the urine, mostly in the form of metabolites, with some excretion also occurring in the feces. INDICATIONS AND CLINICAL USE ELAVIL® (amitriptyline hydrochloride) is indicated in the drug management of depressive illness. ELAVIL® may be used in depressive illness of psychotic or endogenous nature and in selected patients with neurotic depression. Endogenous depression is more likely to be alleviated than are other depressive states. ELAVIL® ®, because of its sedative action, is also of value in alleviating the anxiety component of depression. As with other tricyclic antidepressants, ELAVIL® may precipitate hypomanic episodes in patients with bipolar depression. These drugs are not indicated in mild depressive states and depressive reactions. -
Is Aristada (Aripiprazole Lauroxil) a Safe and Effective Treatment for Schizophrenia in Adult Patients? Kyle J
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Student Dissertations, Theses and Papers Scholarship 2017 Is Aristada (Aripiprazole Lauroxil) a Safe and Effective Treatment For Schizophrenia In Adult Patients? Kyle J. Knowles Philadelphia College of Osteopathic Medicine Follow this and additional works at: https://digitalcommons.pcom.edu/pa_systematic_reviews Part of the Psychiatry Commons Recommended Citation Knowles, Kyle J., "Is Aristada (Aripiprazole Lauroxil) a Safe and Effective Treatment For Schizophrenia In Adult Patients?" (2017). PCOM Physician Assistant Studies Student Scholarship. 381. https://digitalcommons.pcom.edu/pa_systematic_reviews/381 This Selective Evidence-Based Medicine Review is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Physician Assistant Studies Student Scholarship by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Is Aristada (Aripiprazole Lauroxil) a Safe and Effective Treatment For Schizophrenia In Adult Patients? Kyle J. Knowles, PA-S A SELECTIVE EVIDENCE BASED MEDICINE REVIEW In Partial Fulfillment of the Requirements For The Degree of Master of Science In Health Sciences- Physician Assistant Department of Physician Assistant Studies Philadelphia College of Osteopathic Medicine Philadelphia, Pennsylvania December 16, 2016 ABSTRACT OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Is Aristada (aripiprazole lauroxil) a safe and effective treatment for schizophrenia in adult patients?” STUDY DESIGN: Review of three randomized controlled studies. All three trials were conducted between 2014 and 2015. DATA SOURCES: One randomized, controlled trial and two randomized, controlled, double- blind trials found via Cochrane Library and PubMed. -
PERPHENAZINE and AMITRIPTYLINE HYDROCHLORIDE- Perphenazine and Amitriptyline Hydrochloride Tablet, Film Coated Mylan Pharmaceuticals Inc
PERPHENAZINE AND AMITRIPTYLINE HYDROCHLORIDE- perphenazine and amitriptyline hydrochloride tablet, film coated Mylan Pharmaceuticals Inc. ---------- WARNING Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug- treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Perphenazine and amitriptyline hydrochloride is not approved for the treatment of patients with dementia- related psychosis (see WARNINGS). Suicidality and Antidepressant Drugs Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of perphenazine and amitriptyline or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. -
Amitriptyline (Elavil): Important Patient Information
What is most important to remember? If you have questions: Strong Internal Medicine • You must check to make sure that it is safe for you to take Ask your doctor, nurse or pharmacist for amitriptyline with all of your other more information about amitriptyline medicines and health problems (Elavil®). • Do not start any new medications, over-the-counter drugs or herbal remedies without talking to your doctor • Contact your prescriber If your symptoms or health problems do not get any better or they become worse • This medicine comes with an Strong Internal Medicine extra patient fact sheet called a 601 Elmwood Avenue Medication Guide. Read it with Ambulatory Care Facility, 5th Floor care. Read it again each time this Rochester, NY 14642 Phone: (585) 275 -7424 medicine is refilled Amitriptyline (Elavil®): • If you think there has been an Visit our website at: Important Patient Information www.urmc.rochester.edu/medicine/ - overdose, call your poison control general-medicine/patientcare/ center or get medical care right away What does amitriptyline (Elavil®) do? What side effects could occur with amitriptyline What are some things that I need to be aware of when • It belongs to a class of medications called tricyclic (Elavil®)? taking amitriptyline (Elavil®)? antidepressants (TCAs). It works by increasing the • Hard stools (constipation) • Tell your doctor or pharmacist if you are allergic to amitriptyline, any other medicines, foods, or substances amounts of certain natural substances in the brain that • Dizziness, feeling sleepy are needed -
Perphenazine Medical Facts from Drugs.Com Visited 10/07/2015
Perphenazine medical facts from Drugs.com http://www.drugs.com/mtm/perphenazine.html Visited 10/07/2015 Generic Name: perphenazine (per FEN a zeen) Brand Name: Trilafon What is perphenazine? Perphenazine is an anti-psychotic medicine in a group of drugs called phenothiazines (FEEN-oh-THYE-a-zeens). It works by changing the actions of chemicals in your brain. Perphenazine is used to treat psychotic disorders such as schizophrenia. It is also used to control severe nausea and vomiting. Perphenazine may also be used for purposes not listed in this medication guide. What is the most important information I should know about perphenazine? You should not use perphenazine if you have liver disease, brain damage, bone marrow depression, a blood cell disorder, or if you are also using large amounts of alcohol or medicines that make you sleepy. Call your doctor at once if you have twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs. These could be early signs of dangerous side effects. What should I discuss with my healthcare provider before taking perphenazine? You should not use this medicine if you are allergic to any phenothiazine (perphenazine, chlorpromazine, prochlorperazine, promethazine, thioridazine, Compazine, Phenergan, Mellaril, Thorazine, and others), or if you have: liver disease; brain damage; bone marrow depression; a blood cell disorder (such as low platelets or low red or white blood cell counts); or if you are also using large amounts of alcohol or medicines that make you sleepy. Perphenazine is not approved for use in psychotic conditions related to dementia. Perphenazine may increase the risk of death in older adults with dementia-related conditions. -
Perphenazine-151548-PI.Pdf
PRESCRIBING INFORMATION PERPHENAZINE Perphenazine Tablets USP 2 mg , 4 mg, 8mg, and 16 mg Antipsychotic/Antiemetic AA Pharma Inc. DATE OF REVISION: April 12, 2012 1165 Creditsone Road, Unit #1 Vaughan, Ontario L4K 4N7 Control Number: 151548 PRESCRIBING INFORMATION PERPHENAZINE Perphenazine Tablets USP 2 mg, 4 mg, 8 mg and 16 mg THERAPEUTIC CLASSIFICATION Antipsychotic/Antiemetic ACTIONS AND CLINICAL PHARMACOLOGY Perphenazine is a piperazine phenothiazine derivative with antipsychotic, antiemetic and weak sedative activity. Perphenazine has actions similar to those of other phenothiazine derivatives but appears to be less sedating and to have a weak propensity for causing hypotension or potentiating the effects of CNS depressants and anesthetics. However, it produces a high incidence of extrapyramidal reactions. Perphenazine is well absorbed from the gastrointestinal tract. Onset of action following oral administration is 30 to 40 minutes. Duration of action is 3 to 4 hours. Perphenazine distributes to most body tissues with high concentrations being distributed into liver and spleen. Perphenazine enters the enterohepatic circulation and is excreted chiefly in the feces. INDICATIONS AND CLINICAL USE Perphenazine is indicated in the management of manifestations of psychotic disorders. It is also effective in controlling nausea and vomiting due to stimulation of the chemoreceptor trigger zone. 1 Perphenazine has not been shown effective for the management of behavioral complications in patients with mental retardation. CONTRAINDICATIONS Should not be administered in the presence of circulatory collapse, altered states of consciousness or comatose states, particularly when these are due to intoxication with central depressant drugs (alcohol, hypnotics, narcotics). It is contraindicated in severely depressed patients, in the presence of blood dyscrasias, liver disease, renal insufficiency, pheochromocytoma, or in patients with severe cardiovascular disorders or a history of hypersensitivity to phenothiazine derivatives. -
Reversible and Irreversible Dyskinesia After Treatment with Perphenazine, Chlorpromazine, Reserpine and Eleetroeonvulsive Therapy* by L
Psychopharmacologia 1,408--418 (1960) From St. Hans Mental Hospital, Department D., Roskflde, Denmark (A. FAVl~B:Z~,M.D.) Reversible and Irreversible Dyskinesia after Treatment with Perphenazine, Chlorpromazine, Reserpine and Eleetroeonvulsive Therapy* By L. UnRnaANO and A. FAURBYE With 1 Figure in the Text (Received March 5, 1960) Neurological symptoms are often observed as side effects in the treatment of psychoses with psychopharmaca. Such neurological sym- ptoms have hitherto been considered as a minor inconvenience because they disappeared after reduction of the dose or cessation of the treat- ment but now we have observed that neurological symptoms may persist as irreversible phenomena after cessation of the treatment. The neurological symptoms which we have observed being irrevers- ible in some cases is a syndrome (bucco-linguo-mast~catory dyskinesia) consisting of incessant involuntary munching and masticatory move- ments of the jaw during which the tongue is protruded at short intervals with vigorous grimaces of the lips (see Fig. 1). In the most serious cases there are also rocking and torsionary body movements and in- cessant tripping and shuffling movements so that the patient can not stand still. SuA~o~ et al. (1957) have noted in patients treated with perphena- zinc occasional stiffness of the face and neck muscles together with protrusion of the tongue. The attacks disappeared after stopping per- phenazine, reduction of the dose or administration of barbituric acid compounds. CHmSTIAN and PAVLSE~ (1958) describe the case of a patient who was treated with small doses of prochlorperazine (stemetil). On the third day of treatment an alarming state developed with protrusion of the tongue, spasms of the neck muscles, and later on opisthotonus and increasing respiratory trouble. -
Trilafon Tablets & Trilafon Injection Final Printed Labeling
PAGE 1 TRILAFON TABLETS & TRILAFON INJECTION FINAL PRINTED LABELING 1 TRILAFON Ò 2 brand of perphenazine, USP 3 Tablets, 4 Injection 5 6 DESCRIPTION TRILAFON products contain perphenazine, USP (4-[3-(2- 7 chlorophenothiazin-10-yl)propyl]-1-piper-azineethanol), a piperazinyl phenothiazine 8 having the chemical formula, C21H26CIN3OS. They are available as Tablets, 2, 4, 9 8, and 16 mg; and Injection, perphenazine 5 mg per 1 mL. 10 The inactive ingredients for TRILAFON Tablets, 2, 4, 8, and 16 mg, include: 11 acacia, black iron oxide, butylparaben, calcium phosphate, calcium sulfate, 12 carnauba wax, corn starch, lactose, magnesium stearate, sugar, titanium dioxide, 13 and white wax. The inactive ingredients for TRILAFON Injection include: citric 14 acid, sodium bisulfite, sodium hydroxide, and water. 15 ACTIONS Perphenazine has actions at all levels of the central nervous system, 16 particularly the hypothalamus. However, the site and mechanism of action of 17 therapeutic effect are not known. 18 CLINICAL PHARMACOLOGY Pharmacokinetics: Following oral administration 19 of TRILAFON® Tablets, mean peak plasma perphenazine concentrations were 20 observed between 1 to 3 hours. The plasma elimination half-life of perphenazine 21 was independent of dose and ranged between 9 and 12 hours. In a study in which 22 normal volunteers (n=12) received TRILAFON 4 mg q8h for 5 days, steady-state 23 concentrations of perphenazine were reached within 72 hours. Mean (%CV) Cmax 24 and Cmin values for perphenazine and 7-hydroxyperphenazine at steady-state are 25 listed below: 26 ParameterPerphenazine 7-Hydroxyperphenazine 27 Cmax (pg/mL) 984 (43) 509 (25) 28 Cmin (pg/mL) 442 (76) 350 (56) 1 PAGE 2 TRILAFON TABLETS & TRILAFON INJECTION FINAL PRINTED LABELING 29 Peak 7-hydroxyperphenazine concentrations were observed between 2 to 4 hours 30 with a terminal phase half-life ranging between 9.9 to 18.8 hours.