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What is amitriptyline and perphenazine?
Amitriptyline is in a group of drugs called tricyclic antidepressants. Amitriptyline affects chemicals in the brain that may become unbalanced. Perphenazine is in a group of drugs called phenothiazines (feen-oh-THYE-a-zeens). Perphenazine affects chemicals in the brain that may become unbalanced and cause anxiety. The combination of amitriptyline and perphenazine is used to treat depression, anxiety, and agitation. Amitriptyline and perphenazine may also be used for purposes not listed in this medication guide.

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What are the possible side effects of amitriptyline and perphenazine?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

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.

Call your doctor at once if you have any of these serious side effects:

• 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.

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How should I take amitriptyline and perphenazine?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. It may take a few weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment. To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney and liver function may also need to be tested. Do not miss any scheduled appointments.

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What is the most important information I should know about amitriptyline and perphenazine?
Do not use this medication if you are allergic to amitriptyline (Elavil) or perphenazine (Trilafon), or if you have liver disease, a weak immune system, a blood cell disorder (such as anemia), or if you have recently had a heart attack. Do not use amitriptyline and perphenazine if you have taken an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

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What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

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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

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Amitriptyline and perphenazine may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

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What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of amitriptyline and perphenazine can be fatal. Overdose symptoms of an overdose may include uneven heartbeats, extreme drowsiness, confusion, agitation, hallucinations, vomiting, feeling hot or cold, sweating, muscle stiffness, feeling light-headed, fainting, seizure (convulsions), or coma.

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What should I discuss with my healthcare provider before taking amitriptyline and perphenazine?
Do not use this medication if you are allergic to amitriptyline (Elavil) or perphenazine (Trilafon), or if you have: liver damage; a blood cell disorder (such as anemia); a weak immune system (bone marrow depression); or if you have recently had a heart attack. Do not use amitriptyline and perphenazine if you have taken an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take amitriptyline and perphenazine before the MAO inhibitor has cleared from your body.

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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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