The combination medication perphenazine/amitriptyline, also previously known under the brand name Triavil, is used to treat depression with anxiety or schizophrenia in adults. It contains a typical antipsychotic medication and a tricyclic antidepressant (TCA). This combination medication is a tablet that's taken by mouth three or four times per day. Side effects include sleepiness, dizziness, and dry mouth. More serious risks include possible thoughts of suicide and low blood cell counts.
Perphenazine/amitriptyline is a combination of two medications that work together to improve mood and anxiety.
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Contact your healthcare provider immediately if you experience any of the following.
Along with its needed effects, perphenazine (included in this combination medicine) can sometimes cause serious side effects. Tardive dyskinesia (a movement disorder) may occur and may not go away after you stop using the medicine. Signs of tardive dyskinesia include fine, worm-like movements of the tongue, or other uncontrolled movements of the mouth, tongue, cheeks, jaw, or arms and legs. Other serious but rare side effects may also occur. These include severe muscle stiffness, fever, unusual tiredness or weakness, fast heartbeat, difficult breathing, increased sweating, loss of bladder control, and seizures (neuroleptic malignant syndrome). You and your doctor should discuss the good this medicine will do as well as the risks of taking it.
Stop taking this medicine and get emergency help immediately if any of the following effects occur:
Rare
Convulsions (seizures)
difficulty in breathing
fast heartbeat
high or low blood pressure
increased sweating
loss of bladder control
muscle stiffness (severe)
unusual tiredness or weakness
unusually pale skin
Check with your doctor as soon as possible if any of the following side effects occur:
More common
Blurred vision or any change in vision
difficulty in speaking or swallowing
fainting
inability to move eyes
lip smacking or puckering
loss of balance control
mask-like face
muscle spasms, especially of face, neck, and back
nervousness, restlessness, or need to keep moving
puffing of cheeks
rapid or fine, worm-like movements of tongue
shuffling walk
stiffness of arms and legs
trembling and shaking of fingers and hands
tic-like or twitching movements
twisting movements of body
uncontrolled chewing movements
uncontrolled movements of arms or legs
weakness of arms and legs
Less common
Confusion
difficult urination
hallucinations (seeing, hearing, or feeling things that are not there)
increased skin sensitivity to sun
shakiness
slow pulse or irregular heartbeat
Rare
Abdominal or stomach pain
aching muscles or joints
back or leg pain
fever and chills
hot, dry skin or lack of sweating
irritability
loss of appetite
muscle weakness or twitching
nosebleeds
prolonged, painful, inappropriate penile erection
ringing, buzzing, or other unexplained noises in ears
skin rash and itching
sore throat and fever
swelling of face and tongue
swelling of testicles
unusual bleeding or bruising
yellow eyes or skin
Symptoms of overdose
Agitation
confusion
convulsions (seizures)
drowsiness (severe)
enlarged pupils
fast, slow, or irregular heartbeat
hallucinations (seeing, hearing, or feeling things that are not there)
shortness of breath or troubled breathing
unusual tiredness or weakness (severe)
vomiting (severe)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Decreased sweating
dizziness
drowsiness
dryness of mouth
headache
increased appetite for sweets
tiredness or weakness (mild)
unpleasant taste
weight gain (unusual)
After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:
Dizziness
nausea or vomiting
stomach pain
trembling of fingers and hands
symptoms of tardive dyskinesia, including lip smacking or puckering, puffing of cheeks, rapid or fine, worm-like movements of tongue, uncontrolled chewing movements, or uncontrolled movements of arms or legs
After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:
headache
irritability
restlessness
trouble in sleeping, with vivid dreams
unusual excitement
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
The brand name Triavil is discontinued. It isn't clear why the brand name was discontinued, but it wasn't because of safety reasons or because it didn't work well. The generic version of the combination medication is still available, though.
No. Perphenazine/amitriptyline isn't a controlled substance because it doesn't have a risk for addiction or dependence.
In general, it can take a few weeks to a few months for you feel the maximum effects of perphenazine/amitriptyline. Keep in mind that everyone's experience with the medication can be different. So some people can also start noticing improvements in their mood before then. Make sure to continue taking perphenazine/amitriptyline, even if you don't see improvements right away. Contact your prescriber if you're concerned about how well perphenazine/amitriptyline is working to help with your mental health.
Perphenazine/amitriptyline is a combination medication. It takes about 2 to 3 days for perphenazine and about 2 to 6 days for amitriptyline to leave your body after a single dose. This time frame is an estimate based on the half-life of perphenazine and amitriptyline. The half-life of a medication is a measure of how long it takes for your body to clear half of the medication from your system. Even though perphenazine/amitriptyline stays in your system for a few days, you still need to take it every day. This helps keep the levels of the medication high enough so it can work well to treat your condition.
Yes, perphenazine/amitriptyline can make you sleepy. Don't drive or do anything that requires concentration until you know how the medication affects you. Also, don't mix alcohol with the medication because it can make you even sleepier. Contact your prescriber if perphenazine/amitriptyline makes you too sleepy during the day. They might lower your dose or consider switching you to a different medication.
Yes, it's possible for perphenazine/amitriptyline to cause weight gain. Some people who took amitriptyline, one of the components of this combination medication, reported weight gain. Some people gained up to 16 pounds while taking amitriptyline during a study. Note that everyone responds to the medication differently. Talk with your healthcare team if you're concerned about the risk of weight gain while you're taking perphenazine/amitriptyline. They can recommend ways to maintain a healthy body weight, such as eating balanced and nutritious meals that include ingredients like lean proteins, whole grains, fruits, and vegetables. Your care team can also help build a regular exercise routine that's best for you.
Perphenazine/amitriptyline isn't recommended if you're pregnant. There aren't enough studies looking at how this medication affects people who are pregnant and their babies. But in general, taking antipsychotic medications like perphenazine/amitriptyline in the third trimester of pregnancy can be harmful to your baby. Your baby might have movement problems or withdrawal symptoms (e.g., agitation, trouble breathing, poor feeding). If you're pregnant, talk to your prescriber about the risks and benefits of taking perphenazine/amitriptyline. If you're pregnant and you're taking this medication, it's encouraged that you enroll in the National Pregnancy Registry for Antidepressants. This registry monitors your health and your baby's health to help researchers learn more about the safety risks of taking perphenazine/amitriptyline during pregnancy.
Perphenazine/amitriptyline can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
People 65 years and older with dementia sometimes have delusions and hallucinations (believing, seeing, or hearing things that aren't real). This is called dementia-related psychosis. Older people with dementia-related psychosis have a higher risk of death if they take medications like perphenazine/amitriptyline.
Because of this risk, people ages 65 years and older with dementia-related psychosis shouldn't take perphenazine/amitriptyline. Let your prescriber know if you have dementia before you start this medication. Or if you're a caregiver, tell the prescriber that the person you're caring for has dementia.
Taking perphenazine/amitriptyline can make your depression worse. It can also raise your risk for having thoughts of suicide or harming yourself. The risk is highest if you're 24 years of age or younger, during the first few weeks of taking the medication, and when your dose changes.
Contact your prescriber if you or anyone around you notices that you have worsening depression or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness) while you're taking perphenazine/amitriptyline. Get medical help right away if you have any suicidal thoughts.
Depression can be the first sign of bipolar disorder. Taking antidepressants, like perphenazine/amitriptyline, by themselves can lead to a bipolar manic episode in people at risk for bipolar disorder.
Before you start taking perphenazine/amitriptyline, your prescriber will check your risk for bipolar disorder. Perphenazine/amitriptyline isn't used to treat bipolar depression. Speak to your healthcare team right away if you or your loved ones notice unusual changes in your behavior. Signs of a bipolar manic episode include racing thoughts, restlessness, getting easily distracted, and unusual talkativeness.
Antipsychotic medications like perphenazine can cause uncontrolled body movements, such as eye-twitching or lip-smacking. Your risk of this happening and that it becomes permanent is more likely the longer you take medications like perphenazine/amitriptyline and if you're taking a higher dose.
It's also possible to feel restless or unable to sit still, have tremors similar to those related to Parkinson's disease, or unusual body stiffening while you're taking perphenazine/amitriptyline.
Talk to your prescriber right away if you notice any unusual movement problems or any uncontrolled movements and you can't stop them.
Taking antipsychotic medications like perphenazine can cause a rare but life-threatening condition called neuroleptic malignant syndrome (NMS). Seek medical help as soon as possible if you have any symptoms of NMS, including high fever, sweating, stiff muscles, confusion, not being aware of your surroundings, and irregular heartbeat. You'll probably need to stop taking perphenazine/amitriptyline and get treatment. Once your symptoms go away, your prescriber will discuss whether to switch you to a different medication.
Perphenazine/amitriptyline can make you tired, lower your blood pressure when you stand, and make you lose your balance. These side effects can lead to falls. Make sure to slowly get up from a sitting or lying position and hold onto something. This helps prevent you from falling and getting hurt.
Although not common, perphenazine can lower the amount of white blood cells (WBCs) in your body. You might be at risk if you already have low WBC levels from other medical conditions or from other medications. This can raise your risk of serious infection.
If you're at risk, you'll need to get blood tests done regularly during the first few months of taking perphenazine/amitriptyline. These blood tests help your prescriber make sure your blood cell counts are in the normal range. If your WBC levels drop too low, you'll probably need to stop taking perphenazine/amitriptyline.
Contact your prescriber right away if you develop any signs of infection, such as fever, tiredness, chills, cough, or trouble breathing. Your prescriber can recommend ways to treat possible infection.
It's possible for amitriptyline to affect heart rhythm and cause irregular heart beat (e.g., arrhythmia). It can especially happen at high doses of the medication. In addition, some people taking medications like perphenazine/amitriptyline have had a heart attack or stroke during treatment.
Let your prescriber know if you have any heart problems or if you've had a heart attack or stroke before you start taking perphenazine/amitriptyline. People with heart problems should take this medication with caution. Talk to your prescriber about whether perphenazine/amitriptyline is right for you.
Amitriptyline can raise your risk of seizures, especially at higher doses. Be sure your prescriber knows if you've had a seizure before. Discuss with your prescriber about whether perphenazine/amitriptyline is right for you.
Perphenazine/amitriptyline can cause or worsen angle-closure glaucoma in certain people. Contact your prescriber or your eye specialist if you notice changes in your vision after you start taking perphenazine/amitriptyline.
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2mg/10mg | 90 tablets | $57.63 | $0.64 |
| 2mg/25mg | 90 tablets | $56.75 | $0.63 |
| 4mg/10mg | 60 tablets | $34.41 | $0.57 |
| 4mg/25mg | 30 tablets | $24.74 | $0.82 |
| 4mg/50mg | 135 tablets | $87.07 | $0.64 |
The dose depends on how old you are and how severe your symptoms of depression, anxiety, or schizophrenia are.
Starting dose
Maintenance dose
The maximum dose is 16 mg/200 mg (perphenazine/amitriptyline) per day.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Perphenazine/amitriptyline will not be safe for you to take.