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Perphenazine / Amitriptyline Coupon - Perphenazine / Amitriptyline 2mg/25mg tablet

perphenazine / amitriptyline

Generic Triavil
Used for Depression, Anxiety, Schizophrenia
Used for Depression, Anxiety, Schizophrenia

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.

Last reviewed on December 16, 2024
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What is Perphenazine/amitriptyline?

What is Perphenazine/amitriptyline used for?

How Perphenazine/amitriptyline works

Perphenazine/amitriptyline is a combination of two medications that work together to improve mood and anxiety.

Are you looking for information on perphenazine or amitriptyline instead?

Drug Facts

Common BrandsTriavil (brand name no longer available)
Drug ClassAntipsychotic / Tricyclic antidepressant
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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What are the side effects of Perphenazine/amitriptyline?

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.

Common Side Effects

  • Sleepiness
  • Dry mouth
  • Uncontrolled body movements
  • Slowed movements
  • Restlessness
  • Tremors
  • High blood pressure

Other Side Effects

  • Headache
  • Dizziness
  • Weakness
  • Nausea
  • Vomiting
  • Constipation
  • Sweating
  • Itching
  • Skin rash
  • Swelling in legs
  • Hair loss
  • Blurred vision
  • Irregular heartbeat
  • Low blood pressure (particularly when standing from sitting or lying down)
  • Trouble urinating
  • Changes in weight

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Suicidal thoughts and behaviors
  • Tardive dyskinesia (TD): uncontrollable movements like lip smacking, eye blinking, sticking out your tongue, or grimacing
  • Neuroleptic malignant syndrome (NMS): high fever, fast heart rate, full body stiffness, confusion
  • Heart problems: heart attack, irregular heartbeat
  • Stroke: sudden numbness, weakness, confusion, or difficulty talking
  • Seizure

Source: DailyMed

The following side effects have also been reported

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

fever

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

constipation

difficult urination

eye pain

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

hair loss

hot, dry skin or lack of sweating

irritability

loss of appetite

muscle weakness or twitching

nausea, vomiting, or diarrhea

nosebleeds

prolonged, painful, inappropriate penile erection

ringing, buzzing, or other unexplained noises in ears

skin discoloration

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

fever

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

nasal congestion

tiredness or weakness (mild)

unpleasant taste

weight gain (unusual)

Less common

Changes in menstrual period

decreased sexual ability

heartburn

increased sweating

swelling or pain in breasts or unusual secretion of milk

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:

Diarrhea

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.

pros-and-cons

Pros and cons of Perphenazine/amitriptyline

thumbs-up

Pros

Convenient to take one pill that contains two medications

Taken by mouth

Can take with or without food

thumbs-down

Cons

Need to take two to four times per day

Hard to customize the dose since it's a combination of two medications

Can cause unpleasant withdrawal symptoms if you suddenly stop taking the medication

Might not be a good option for people with heart problems, seizures, difficulty urinating, or glaucoma

pharmacist-tips

Pharmacist tips for Perphenazine/amitriptyline

pharmacist
  • Take perphenazine/amitriptyline with or without food. If the medication upsets your stomach, taking it with food might help.

    • Don't change your dose or suddenly stop taking perphenazine/amitriptyline without talking to your prescriber first. Otherwise, you might start to have bothersome withdrawal symptoms, like nausea, restlessness, disturbed sleep, or stiff muscles.

      • Avoid alcohol while you're taking perphenazine/amitriptyline. It can make sleepiness and dizziness from the medication more intense. Alcohol can also worsen your depression and anxiety symptoms in the long run. Talk with your healthcare team about your drinking habits. They can discuss with you about ways to avoid alcohol or resources to help you stop drinking.

        • Perphenazine/amitriptyline can raise the risk of worsening depression or suicidal thoughts. Seek medical help right away if you notice any new or worsening changes in your behavior or mood while you're taking this medication.

          • Although rare, perphenazine/amitriptyline can cause difficulty swallowing. This can raise the risk for choking. Make sure to take small bites of food and eat slowly.

            • Contact your prescriber right away if you have any uncontrolled body movements, including fidgeting, lip-smacking, or tremors. These are possible side effects from perphenazine/amitriptyline. Your prescriber can lower your dose to help with these side effects. They might also prescribe you a medication called benztropine to treat these movement problems.

              • Perphenazine/amitriptyline can cause changes to your blood sugar levels. If you have diabetes, ask your prescriber whether you need to check your blood sugar more often while you're taking this medication. You can also discuss with them about any needed changes to your diabetes treatment plan.

                • Talk to your prescriber as soon as you know you're going to have surgery. You might need to stop perphenazine/amitriptyline because it can interact with certain medications used during surgery and cause your blood pressure to drop. Also be sure to let your surgery team know that perphenazine/amitriptyline is one of the medications you take.

                  faqs

                  Frequently asked questions about Perphenazine/amitriptyline

                  Why was Triavil discontinued?
                  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.
                  Is perphenazine/amitriptyline a controlled substance?
                  No. Perphenazine/amitriptyline isn't a controlled substance because it doesn't have a risk for addiction or dependence.
                  How long does perphenazine/amitriptyline take to work?
                  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.
                  How long does perphenazine/amitriptyline stay in your system?
                  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.
                  Does perphenazine/amitriptyline make you sleepy?
                  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.
                  Does perphenazine/amitriptyline cause weight gain?
                  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.
                  Can you take perphenazine/amitriptyline during pregnancy?
                  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.
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                  What are the risks and warnings for Perphenazine/amitriptyline?

                  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.

                  risk-warning

                  Higher risk of death in older people with dementia-related psychosis

                  • Risk factors: Age 65 and older with dementia and psychosis

                    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.

                    risk-warning

                    Worsening depression, suicidal thoughts, and unusual behavior

                    • Risk factors: Age under 24 years old | History of depression or other mental health conditions

                      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.

                      risk-warning

                      Not for use alone in bipolar disorder

                      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.

                      risk-warning

                      Movement problems, including difficulty controlling body movements

                      • Risk factors: Taking other antipsychotic medications | Older age | Females of older age | High dose | Taking perphenazine/amitriptyline for a long period of time

                        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.

                        risk-warning

                        Neuroleptic malignant syndrome

                        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.

                        risk-warning

                        Higher risk of falls

                        • Risk factors: Low blood pressure | Taking medications that lower blood pressure or cause drowsiness | Older age

                          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.

                          risk-warning

                          Low white blood cell counts

                          • Risk factors: History of low blood cell counts

                            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.

                            risk-warning

                            Risk for heart problems or stroke

                            • Risk factors: High dose of perphenazine/amitriptyline

                              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.

                              risk-warning

                              Seizures

                              • Risk factors: History of seizures | Taking high doses of perphenazine/amitriptyline

                                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.

                                risk-warning

                                Glaucoma

                                • Risk factors: History of angle-closure glaucoma

                                  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

                                  Perphenazine/amitriptyline dosage forms

                                  The average cost for 90 tablets of 2mg/25mg of Perphenazine/amitriptyline is $30.46 with a free GoodRx coupon. This is 82.28% off the average retail price of $171.86.
                                  tablet
                                  Tablet
                                  DosageQuantityPrice as low asPrice per unit
                                  2mg/10mg90 tablets$25.86$0.29
                                  4mg/10mg60 tablets$20.07$0.33
                                  2mg/25mg90 tablets$30.46$0.34
                                  4mg/25mg30 tablets$16.79$0.56
                                  4mg/50mg90 tablets$47.60$0.53

                                  Typical dosing for Perphenazine/amitriptyline

                                  The dose depends on how old you are and how severe your symptoms of depression, anxiety, or schizophrenia are.

                                  Starting dose

                                  • Anxiety and depression: The usual starting dose is one tablet of 2 mg/25 mg or 4 mg/25 mg (perphenazine/amitriptyline) by mouth three or four times per day. You can also take the 4 mg/50 mg (perphenazine/amitriptyline) tablet by mouth twice per day.

                                  • Severe schizophrenia with depressive symptoms: The usual starting dose is two tablets of 4 mg/25 mg (perphenazine/amitriptyline) by mouth three times per day. If needed, your prescriber might add another 4 mg/25 mg (perphenazine/amitriptyline) tablet to take at bedtime.

                                  • People ages 65 years and older, adolescents, or people who have more anxiety than depression: The usual starting dose is one tablet of 4 mg/10 mg (perphenazine/amitriptyline) by mouth three or four times per day.

                                  Maintenance dose

                                  • After your symptoms get better, your prescriber might change your dose of perphenazine/amitriptyline so you're taking the lowest dose possible for your condition.

                                  • A typical maintenance dose is one tablet of 2 mg/25 mg or 4 mg/25 mg (perphenazine/amitriptyline) by mouth two to four times per day. You can also take the 4 mg/50 mg (perphenazine/amitriptyline) tablet by mouth twice per day.

                                  The maximum dose is 16 mg/200 mg (perphenazine/amitriptyline) per day.

                                  interactions

                                  Interactions between Perphenazine/amitriptyline and other drugs

                                  Perphenazine/amitriptyline may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Perphenazine/amitriptyline. Please note that only the generic name of each medication is listed below.

                                  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.

                                  drug-cost

                                  How much does Perphenazine/amitriptyline cost?

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                                  contraindications-icon

                                  Perphenazine/amitriptyline contraindications

                                  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.
                                  • Slowed brain activity (slowed breathing, slow heartbeat, slow or no response to sound or touch) from taking barbiturates (e.g., phenobarbital), sedatives, opioids, or antihistamines

                                  • Low blood cell counts when your bone marrow makes fewer blood cells (bone marrow suppression)

                                  • Currently taking or have recently taken (in the last 14 days) a monoamine oxidase inhibitor (MAOI)

                                  • Recent heart attack

                                  alternatives

                                  What are alternatives to Perphenazine/amitriptyline?

                                  There are a number of medications that your doctor can prescribe in place of Perphenazine/amitriptyline. Compare a few possible alternatives below.
                                  Perphenazine/amitriptyline
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                                  $10.20 Lowest GoodRx priceView Prices
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                                  References

                                  Best studies we found

                                  Drugs@FDA: FDA-Approved Drugs. (n.d.). Products on NDA 014715. U.S. Food and Drug Administration.

                                  MedlinePlus. (2024). Psychosis.

                                  Moret, C., et al. (2011). The importance of norepinephrine in depression. Neuropsychiatric Disease and Treatment.

                                  View All References (6)

                                  Mylan Pharmaceuticals Inc. (2024). Perphenazine and amitriptyline hydrochloride tablet, film coated [package insert]. DailyMed.

                                  National Heart, Lung, and Blood Institute. (2022). What is an arrhythmia?

                                  Reeves, R. R., et al. (2010). Antidepressant-induced suicidality: An update. Central Nervous System Neuroscience & Therapeutics.

                                  Takeuchi, H., et al. (2014). Impact of once- versus twice-daily perphenazine dosing on clinical outcomes: An analysis of the CATIE data. The Journal of Clinical Psychiatry.

                                  Thour, A., et al. (2023). Amitriptyline. StatPearls.

                                  Wharton, S., et al. (2018). Medications that cause weight gain and alternatives in Canada: A narrative review. Diabetes, Metabolic Syndrome and Obesity.

                                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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