Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

• restless muscle movements in your eyes, tongue, jaw, or neck;

• tremor (uncontrolled shaking);

• fever, stiff muscles, confusion, sweating, fast or uneven heartbeats;

• feeling like you might pass out;

• seizures (convulsions);

• problems with urination;

• fast, or slow heart rate, chest pain or heavy feeling;

• easy bruising or bleeding;

• jaundice (yellowing of your skin or eyes); or

• urinating less than usual or not at all.

Less serious side effects may include:

• feeling dizzy, drowsy, or tired;

• strange dreams or nightmares;

• sleep problems (insomnia);

• dry mouth, loss of appetite;

• nausea, vomiting, diarrhea, constipation;

• blurred vision;

• breast changes; or

• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect amitriptyline and perphenazine?

Before taking amitriptyline and perphenazine, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

The following drugs can interact with amitriptyline and perphenazine. Tell your doctor if you are using any of these:

• atropine (Atreza, Sal-Tropine, and others);

• cimetidine (Tagamet;

• guanethidine (Ismelin); or

• a heart rhythm medicine such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Quinidex, Quinaglute).

This list is not complete and there may be other drugs that can interact with amitriptyline and perphenazine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about amitriptyline and perphenazine.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.