Perphenazine

Perphenazine

Clinical data
AHFS/Drugs.com	Monograph
MedlinePlus	a682165
Pregnancy category	AU: C US: C (Risk not ruled out)
Routes of administration	Oral and IM
ATC code	N05AB03 (WHO)
Legal status
Legal status	UK: POM (Prescription only) US: ℞-only
Pharmacokinetic data
Bioavailability	40%
Metabolism	hepatic
Biological half-life	8-12 (up to 20) hours
Identifiers
IUPAC name 2-[4-[3-(2-chloro-10H-phenothiazin-10-yl) propyl]piperazin-1-yl]ethanol
CAS Number	58-39-9 Y
PubChem CID	4748
IUPHAR/BPS	209
DrugBank	DB00850 Y
ChemSpider	4586 Y
UNII	FTA7XXY4EZ
KEGG	D00503 Y
ChEBI	CHEBI:8028 Y
ChEMBL	CHEMBL567 Y
ECHA InfoCard	100.000.346
Chemical and physical data
Formula	C21H26ClN3OS
Molar mass	403.97
3D model (Jmol)	Interactive image
SMILES Clc2cc1N(c3c(Sc1cc2)cccc3)CCCN4CCN(CCO)CC4
InChI InChI=1S/C21H26ClN3OS/c22-17-6-7-21-19(16-17)25(18-4-1-2-5-20(18)27-21)9-3-8-23-10-12-24(13-11-23)14-15-26/h1-2,4-7,16,26H,3,8-15H2 Y Key:RGCVKNLCSQQDEP-UHFFFAOYSA-N Y

Perphenazine is a typical antipsychotic drug. Chemically, it is classified as a piperazinyl phenothiazine. Originally marketed in the US as Trilafon, it has been in clinical use for decades.

Perphenazine is roughly five times as potent as chlorpromazine; thus perphenazine is considered a medium-potency antipsychotic.

Perphenazine is used to treat psychosis (e.g. in people with schizophrenia and the manic phases of bipolar disorder). Perphenazine effectively treats the positive symptoms of schizophrenia, such as hallucinations and delusions, but its effectiveness in treating the negative symptoms of schizophrenia, such as flattened affect and poverty of speech, is unclear. Earlier studies found the typical antipsychotics to be ineffective or poorly effective in the treatment of negative symptoms, but two recent, large-scale studies found no difference between perphenazine and the atypical antipsychotics.

In low doses it is used to treat agitated depression (together with an antidepressant). Fixed combinations of perphenazine and the tricyclic antidepressant amitriptyline in different proportions of weight exist (see Etrafon below). When treating depression, perphenazine is discontinued as fast as the clinical situation allows. Perphenazine has no intrinsic antidepressive activity. Several studies show that the use of perphenazine with fluoxetine (Prozac) in patients with psychotic depression is most promising, although fluoxetine interferes with the metabolism of perphenazine, causing higher plasma levels of perphenazine and a longer half-life. In this combination the strong antiemetic action of perphenazine attenuates fluoxetine-induced nausea and vomiting (emesis), as well as the initial agitation caused by fluoxetine. Both actions can be helpful for many patients.