What Meds

Psychiatric Medications


Amitriptyline and Perphenazine
Brand Names: Etrafon, Etrafon-A, Etrafon-Forte, Triavil, PMS—Levazine

Overview
Etrafon is a common brand name for a medication that contains both amitriptyline and perphenazine. Amitriptyline is a tricyclic antidepressant (TCA), and perphenazine is a potent antipsychotic. Amitriptyline blocks transporters for the chemicals serotonin and norepinephrine, increasing their levels in the brain. Perphenazine blocks dopamine and alpha-adrenergic receptors in the brain and decreases the release of hormones from the hypothalamus and pituitary gland. Alone, amitriptyline is used to treat depression; perphenazine alone is used to treat anxiety and agitation.

This combination is available in several variations so that the amount of each medicine can be customized to the patient. Some combinations of amitriptyline and perphenazine include:

Etrafon or Triavil tablets: amitriptyline 10 or 25 mg, perphenazine 2 mg
Etrafon-A tablets or Triavil tablets: amitriptyline 10 mg, perphenazine 4 mg
Etrafon-Forte tablets or Triavil tablets: amitriptyline 25 mg, perphenazine 4 mg
Triavil tablets: amitriptyline 50 mg, perphenazine 4 mg

Often, brand names for this combination drug are listed with only amitriptyline or only perphenazine, but it is important to keep in mind that Etrafon and Triavil contain both drugs. Information on risks, side effects, drug interactions, and so on for each drug separately still applies to the combination.

Why is this drug prescribed?
Triavil is FDA-approved for severe anxiety associated with agitation, and depression with anxiety/agitation.

Etrafon is oten used to treat:

How much of this drug is typically used?
    2-10: Amitriptyline 10 mg and perphenazine 2 mg
    2-25: Amitriptyline 25 mg and perphenazine 2 mg
    4-10: Amitriptyline 10 mg and perphenazine 4 mg
    4-25: Amitriptyline 25 mg and perphenazine 4 mg
    4-50: Amitriptyline 50 mg and perphenazine 4 mg

Warnings and Precautions
Etrafon is not recommended for children under 12 years old.

In children age 12 to 17, dosage should begin lower than the normal adult dose. In children, some side effects are more likely to occur than in adults, especially muscle spasms of the face, neck, and back, tic-like or twitching movements, inability to move the eyes, twisting of the body, or weakness of the arms and legs. Children are more sensitive to the effects or Etrafon than are adults.

Etrafon should not be discontinued suddenly. Dosage should be tapered gradually, especially following long-term treatment, to minimize withdrawal symptoms.

When a medication containing perphenazine is taken for a long time, patients are advised to take a riboflavin (vitamin B2) supplement.

Etrafon may cause drowsiness — patients should not drive or operate heavy machinery until they know that they can safely engage in such activities.

Etrafon may cause increased sensitivity to sunlight (photosensitivity), and reduce the ability to sweat. Patients should avoid saunas, extreme heat, sun lamps, and should wear sunscreen and avoid sun exposure during the middle of the day.

For Pregnant or Nursing Mothers: Etrafon has not been shown to cause birth defects in animal studies. However, some side effects such as tremors have occurred in some newborn babies whose mothers received other phenothiazines during pregnancy. Etrafon passes into breast milk, and may cause drowsiness and other side effects in infants. Etrafon is not recommended for pregnant or nursing women.

Contraindications
Etrafon should Not be used for people with the following medical conditions:

Precautions
Etrafon may be used with caution in people with the following conditions:

Adverse Reactions
Etrafon may cause the following reactions:

Rarely:

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Etrafon include:

Research Studies and Use in Child Psychiatry
Not studied in children. This medication is now rarely used in adults, and almost never in children.  The medication carries a special warning, as with other antidepressants, of increased suicidal thinking and behavior in adolescents and young adults.

Sources

Stanford Medicine Resources:

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