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Generic name: Amitriptyline hydrochloride with Perphenazine
Brand names: Triavil

Why is Amitriptyline hydrochloride with Perphenazine prescribed?

Triavil is used to treat anxiety, agitation, and depression. Triavil is a combination of a tricyclic antidepressant (amitriptyline) and a tranquilizer (perphenazine).

Triavil can also help people with schizophrenia (distorted sense of reality) who are depressed and people with insomnia, fatigue, loss of interest, loss of appetite, or a slowing of physical and mental reactions.

Most important fact about Amitriptyline hydrochloride with Perphenazine

Triavil may cause tardive dyskinesia--a condition marked by involuntary muscle spasms and twitches in the face and body. This condition may be permanent and appears to be most common among the elderly, especially women. Ask your doctor for information about this possible risk.

How should you take Amitriptyline hydrochloride with Perphenazine?

Triavil may be taken with or without food. You should not take it with alcohol. In addition, Triavil should not be taken within 2 hours of antacids or diarrhea medication.

--If you miss a dose...

Take it as soon as you remember. If it is within 2 hours of your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly closed container. Protect Triavil 2-10 tablets from light.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Triavil.

• More common side effects may include:
  Disorientation, dry mouth, high or low blood pressure, nervous system disorders, sedation

Why should Amitriptyline hydrochloride with Perphenazine not be prescribed?

You should not be using Triavil if you are taking drugs that slow down the central nervous system, including alcohol, barbiturates, analgesics, antihistamines, or narcotics.

Triavil should not be used if you are recovering from a recent heart attack, or if you have an abnormal bone marrow condition. Avoid Triavil if you have ever had an allergic reaction to phenothiazines or amitriptyline.

People who are taking antidepressant drugs known as MAO inhibitors (including Nardil and Parnate) should not take Triavil.

Special warnings about Amitriptyline hydrochloride with Perphenazine

In clinical studies, antidepressants increased the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Triavil or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Triavil is not approved for use in children.

Additionally, the progression of major depression is associated with a worsening of symptoms and/or the emergence of suicidal thinking or behavior in both adults and children, whether or not they are taking antidepressants. Individuals being treated with Triavil and their caregivers should watch for any change in symptoms or any new symptoms that appear suddenly--especially agitation, anxiety, hostility, panic, restlessness, extreme hyperactivity, and suicidal thinking or behavior--and report them to the doctor immediately. Be especially observant at the beginning of treatment or whenever there is a change in dose.

Before using Triavil, tell your doctor if you have ever had the following: glaucoma (high pressure in the eye); difficulty urinating; breast cancer; breathing problems; seizures; heart, liver, kidney, or thyroid disease; or if you are exposed to extreme heat or pesticides. Be aware that Triavil may mask signs of brain tumor, intestinal blockage, and overdose of other drugs.

Nausea, headache, and a general ill feeling can result if you suddenly stop taking Triavil. Follow your doctor's instructions closely when discontinuing Triavil. If your dose is gradually reduced, you may experience irritability, restlessness, and dream and sleep disturbances, but these effects will not last.

This drug may impair your ability to drive a car or operate potentially dangerous machinery. Do not participate in any activities that require full alertness if you are unsure about your ability.

If you develop a fever that has no other cause, stop taking Triavil and call your doctor.

Drugs such as Triavil are known to trigger a potentially fatal condition known as Neuroleptic Malignant Syndrome (NMS). Symptoms include high fever, muscle rigidity, unstable blood pressure, rapid or irregular heartbeat, and excessive sweating. If any of these symptoms develop, contact your doctor immediately.

Triavil could make you more sensitive to sunlight. Be careful to stay out of the sun, wear protective clothing, and use sunblock.

Triavil could also trigger a manic episode in people with bipolar disorder, although the drug's tranquilizing effects seem to reduce this risk.

While taking Amitriptyline hydrochloride with Perphenazine, you may feel dizzy or light-headed or actually faint when getting up from a lying or sitting position. If getting up more slowly doesn't help or if the problem continues, contact your doctor.

Tell the doctor or dentist you're taking Triavil before having any surgery, dental work, or diagnostic procedure. Triavil could interact with anesthetics, muscle relaxants, and other drugs used during surgical procedures.

Possible food and drug interactions when taking Amitriptyline hydrochloride with Perphenazine

Triavil contains the same active ingredients as Elavil and Trilafon and should not be used with these drugs.

If Triavil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Triavil with the following:

Airway-opening drugs such as Proventil
Antidepressants classified as MAO inhibitors, including Nardil and Parnate
Antidepressants that boost serotonin, including fluvoxamine, Paxil, Prozac, and Zoloft
Antiseizure drugs such as Dilantin
Antihistamines such as Benadryl
Antispasmodic drugs such as Bentyl
Atropine (Donnatal)
Barbiturates such as phenobarbital
Blood pressure medications
Blood-thinning drugs such as Coumadin
Cimetidine (Tagamet)
Disulfiram (Antabuse)
Epinephrine (EpiPen)
Ethchlorvynol (Placidyl)
Flecainide (Tambocor)
Fluoxetine (Prozac)
Fluphenazine (Prolixin)
Furazolidone (Furoxone)
Guanethidine
Major tranquilizers such as Haldol
Narcotic analgesics such as Percocet
Phosphorus insecticides
Propafenone (Rythmol)
Quinidine
Thioridazine (Mellaril)
Thyroid medications such as Synthroid

Extreme drowsiness and other potentially serious effects can result if Triavil is combined with alcohol or other central nervous system depressants such as narcotics, painkillers, and sleep medications.

Special information if you are pregnant or breastfeeding

Triavil may cause false-positive results on pregnancy tests. Triavil should not be used by pregnant women or mothers who are breastfeeding.

Recommended dosage

Your doctor will individualize your dose.

You should not take more than 4 tablets of Triavil 4-50 or 8 tablets of any other strength in one day. It may be a few days to a few weeks before you notice any improvement.

ADULTS

For Non-Psychotic Anxiety and Depression

The usual dose is 1 tablet of Triavil 2-25 or 4-25 taken 3 or 4 times a day, or 1 tablet of Triavil 4-50 taken twice a day.

For Anxiety in People with Schizophrenia

The usual dose is 2 tablets of Triavil 4-25 taken 3 times a day. Your doctor may tell you to take another tablet of Triavil 4-25 at bedtime, if needed.

If you need to keep taking Triavil, your doctor will probably have you take 1 tablet of Triavil 2-25 or 4-25 from 2 to 4 times a day or 1 tablet of Triavil 4-50 twice a day.

CHILDREN

Children should not use Triavil.

OLDER ADULTS AND ADOLESCENTS

For Anxiety

The usual dose is 1 tablet of Triavil 4-10, taken 3 or 4 times a day. People in these age groups usually take Triavil at lower doses.

Overdosage

Any medication taken in excess can have serious consequences. An overdose of Triavil can be fatal. If you suspect an overdose, seek medical help immediately.

• Symptoms of Triavil overdose may include:
  Abnormalities of posture and movements, agitation, coma, convulsions, dilated pupils, drowsiness, extreme low body temperature, eye movement problems, high fever, heart failure, overactive reflexes, rapid or irregular heartbeat, rigid muscles, stupor, very low blood pressure, vomiting