How the Drug Works:



Amitriptyline acts on the central nervous system (brain) to exert its antidepressant effects. Chlordiazepoxide acts on the central nervous system to effect emotional responses. Perphenazine acts on the central nervous system to exert its antipsychotic effects.

Precautions:

Neuroleptic Malignant Syndrome (NMS): (NMS)is a potentially fatal syndrome associated with perphenazine. Symptoms include increased body heat, muscle rigidity, altered mental abilities including catatonia (eg, confusion, withdrawal, unresponsivness), irregular pulse and blood pressure, increased heart rate, and sweating.

Tardive dyskinesia: Involuntary and uncontrollable movements may develop in patients treated with perphenazine. The likelihood that these symptoms will become permanent increases with long-term use and with high doses. However, it is possible to develop these symptoms after short-term treatment at low doses. Occurrence is highest among the elderly. The syndrome is characterized by rhythmical involuntary movements of the tongue, face, mouth, or jaw (eg, protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements), sometimes accompanied by involuntary movement of the arms and legs. Fine worm-like movements of the tongue may be an early sign of the syndrome. If the medication is stopped at this time, the syndrome may not develop. There is no known treatment for established cases of tardive dyskinesia, although the syndrome may stop, partially or completely, if the drug is withdrawn.

Pregnancy: Safety and effectiveness of psychotherapeutic combinations during pregnancy have not been established. Studies suggest an increased risk of congenital malformations associated with use of minor tranquilizers (chlordiazepoxide, diazepam, meprobamate) during the first trimester of pregnancy. Use of these drugs during pregnancy should almost always be avoided. Use only if clearly needed and potential benefit to the mother outweigh the possible risk to the fetus.

Breastfeeding: It is not known whether these drugs are excreted in human milk. As a general rule, breastfeeding should not be undertaken while on these drugs, because many drugs are excreted in human milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness of chlordiazepoxide and amitriptyline HCI in children younger than 12 years of age have not been established. Perphenazine and amitriptyline HCI combination is not recommended for use in children.

Elderly: Lowest effective dose is recommended to prevent in coordination, over sedation, confusion, or anticholinergic effects (eg, dry mouth, confusion, blurred vision, constipation, urinary retention).

Lab Tests: Lab tests or exams may be required during treatment with psychotherapeutic combinations. Tests may include periodic kidney and liver function tests and blood counts.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with psychotherapeutic combinations. Doses of one or both drugs may need to be modified or a different drug may need to be pre­scribed. The following drugs and drug classes interact with psychotherapeutic combinations.

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  Alcohol anticholinergics (eg, scopolamine) (perphenazine only)
  
  



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  Anticoagulants (eg, dicumarol)
  
  



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  Antifungal agents (eg, ketoconazole)
  
  



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  Beta blockers (eg, propranolol) (chlordiazepoxide only)
  
  



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  Carbamazepine (eg, Tegretol)
  
  



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  Cimetidine (eg, Tagamet)
  
  



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  Clonidine (eg, Catapres)
  
  



• CNS depressants (eg, barbiturates, narcotics)

Side Effects:

Every drug is capable of producing side effects. Many patients taking psychotherapeutic combinations experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects Include:

Withdrawal symptoms include convulsions , tremor , stomach and muscle cramps, vomiting, sweating.

Digestive Tract: Constipation; loss of appetite; bloating; nausea; stomach upset; vomiting; peculiar taste; diarrhea.

Nervous System: Drowsiness; dizziness; vivid dreams; confusion; tremor; fatigue; weakness; restlessness; lethargy; apprehension; poor concentration; delusions; hallucinations; in coordination; clumsiness; numb­ness; tingling and abnormal skin sensations of the arms and legs; fainting; headache.

Other: Dry mouth; impotence; nasal congestion; fast heartbeat; pounding in the chest; blurred vision; inability to urinate; rash; hives; increased sensitivity to light; itching; excessive or spontaneous flow of breast milk; menstrual irregularities; changes in blood sugar levels; increased sweating; frequent urination; dilated pupils; yellowing of the skin and eyes; hair loss; glandular swelling.

 

Guidelines for Use:

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  Optimum dosage varies with the severity of the symptoms and the patient response. When satisfactory response is obtained, dosage should be reduced to the smallest amount needed to maintain satisfactory response.
  
  



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  Chlordiazepoxide and amitriptyline - Initial dosage of 3 or 4 tablets daily in divided doses is recommended. The larger portion of the total daily dose may be taken at bedtime. In some patients, a single dose at bedtime may be sufficient.
  
  



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  Perphenazine and amitriptyline - Usual initial dose is 3 to 4 tablets daily in divided doses. Lower inital doses may be used in adolescents and the elderly.
  
  



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  Take only the amount prescribed by your doctor. Some of these medicines may be habit-forming and may produce dependence. Consult your doctor before increasing the dose or stopping the medicine.
  
  



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  To avoid withdrawal symptoms after long-term use, a gradual dosage tapering schedule should be followed.
  
  



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  Do not use in combination with MAOls or within 14 days of discontinuing treatment with an MAOI. After stopping these medicines, wait at least 14 days before starting an MAOI.
  
  



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  Avoid alcohol and other mental depressants (eg, narcotics, tranquilizers, antihistamines) while you are taking psychotherapeutic combinations.