$Unique_ID{BRK02081}
$Pretitle{}
$Title{PERPHENAZINE AND AMITRIPTYLINE COMBINATION}
$Subject{Etrafon (Schering)
Triavil (Merck Sharp & Dohme)}
$Volume{}
$Log{
Triavil 2 + 10*0208101.scf
Triavil 2 + 25*0208102.scf
Triavil 4 + 10*0208103.scf
Triavil 4 + 25*0208104.scf}

Copyright (C) 1991 Publications International, Ltd.


PERPHENAZINE AND AMITRIPTYLINE COMBINATION
------------------------------------------------------------------------------

BRAND NAMES (Manufacturers):
     Etrafon (Schering)
     Triavil (Merck Sharp & Dohme)
TYPE OF DRUG:
     Phenothiazine tranquilizer and tricyclic antidepressant
INGREDIENTS:
     perphenazine and amitriptyline
DOSAGE FORM:
     Tablets (2 mg perphenazine and 10 mg amitriptyline; 2 mg perphenazine and
       25 mg amitriptyline; 4 mg perphenazine and 10 mg amitriptyline; 4 mg
       perphenazine and 25 mg amitriptyline; and 4 mg perphenazine and 50 mg
       amitriptyline)
STORAGE:
     Store at room temperature in a tightly closed, light-resistant container.

USES

     Perphenazine and amitriptyline combination is used to relieve anxiety or
depression.  Amitriptyline belongs to a group of drugs referred to as
tricyclic antidepressants.  These medicines are thought to relieve depression
by increasing the concentration of certain chemicals in the brain.
Perphenazine is a phenothiazine tranquilizer.  It is thought to relieve the
symptoms of mental illness by blocking certain chemicals involved with nerve
transmission in the brain.

TREATMENT

     This medication should be taken exactly as your doctor prescribes.  In
order to avoid stomach irritation, you can take the tablets with food or with
a full glass of water or milk (unless your doctor directs you to do
otherwise).
     Antacids and antidiarrheal medicines may decrease the absorption of this
medication from the gastrointestinal tract.  Therefore, at least one hour
should separate doses of perphenazine and amitriptyline combination and one of
these medicines.
     If you miss a dose of this medication, take the missed dose as soon as
possible, unless it is within two hours of your next scheduled dose.  In that
case, do not take the missed dose at all; just return to your regular dosing
schedule.  Do not double the next dose.
     The full benefits of this medication for the control of emotional or
mental symptoms may not become apparent for two weeks after you start to take
it.

SIDE EFFECTS

     Minor.

     Bloating, blurred vision, constipation, cramps, decreased or increased
sweating, diarrhea, dizziness, drowsiness, dry mouth, fatigue, headache,
heartburn, insomnia, loss of appetite, nasal congestion, nausea, peculiar
tastes in the mouth, restlessness, stomach upset, vomiting, weakness, or
weight gain or loss.  These side effects should disappear as your body adjusts
to the medication.
     This medication can increase your sensitivity to sunlight.  You should,
therefore, avoid prolonged exposure to sunlight and sunlamps.  Wear protective
clothing and sunglasses, and use an effective sunscreen.
     This drug combination may cause a discoloration of the urine.  This is a
harmless effect.
     If you experience dry mouth, you might want to try chewing sugarless gum
or sucking on ice chips or a piece of hard candy.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads), exercise, and
drink more water (unless your doctor directs you to do otherwise).
     To avoid dizziness and light-headedness when you stand, contract and
relax the muscles of your legs for a few moments before rising.  Do this by
pushing one foot against the floor while raising the other foot slightly,
alternating feet so that you are "pumping" your legs in a pedaling motion.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
agitation, confusion, convulsions, difficult or painful urination, enlarged or
painful breasts (in both sexes), fainting, fever, hair loss, hallucinations,
chest tightness, impotence, menstrual irregularities, mood changes, mouth
sores, nervousness, nightmares, numbness in fingers or toes, palpitations,
rash, ringing in the ears, sore throat, tremors, uncoordinated movements or
balance problems, unusual bleeding or bruising, or yellowing of the eyes or
skin.

INTERACTIONS

     This drug interacts with several other types of drugs:
     1. Extreme drowsiness can occur if this medication is taken with central
nervous system depressants (such as alcohol, antihistamines, barbiturates,
benzodiazepine tranquilizers, muscle relaxants, narcotics, pain medications,
and sleeping medications) or with other antidepressants.
     2. Amitriptyline may decrease the effectiveness of antiseizure
medications and block the blood-pressure-lowering effects of clonidine and
guanethidine.
     3. Estrogens and oral contraceptives (birth control pills) can increase
the side effects and reduce the effectiveness of amitriptyline.
     4. Amitriptyline may increase the side effects of thyroid medication and
of over-the-counter (nonprescription) cough, cold, allergy, asthma, sinus, and
diet medications.
     5. The concurrent use of this medication with monoamine oxidase (MAO)
inhibitors should be avoided, because the combination may result in fever,
convulsions, or high blood pressure.  At least 14 days should separate the use
of this drug and the use of an MAO inhibitor.
     6. Perphenazine can decrease the effectiveness of amphetamines,
guanethidine, anticonvulsants, and levodopa.
     7. The side effects of epinephrine and propranolol may be increased by
perphenazine.
     Before starting to take this medication, BE SURE TO TELL YOUR DOCTOR
about any medications you are currently taking, especially any of those listed
above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
any medications, especially to perphenazine or other phenothiazine
tranquilizers (such as chlorpromazine, mesoridazine fluphenazine, promazine,
thioridazine, and prochlorperazine), or to amitriptyline or other tricyclic
antidepressants (such as desipramine, doxepin, imipramine, and nortriptyline).
     * Tell your doctor if you have ever had asthma, breast cancer, brain
disease, diabetes mellitus, electroshock therapy, epilepsy, glaucoma, heart
disease, a heart attack, liver disease, lung disease, kidney disease, thyroid
disease, intestinal or urinary tract blockage, low or high blood pressure,
Parkinson's disease, peptic ulcers, or an enlarged prostate.
     * The effects of this medication may last as long as seven days after you
have stopped taking it, so continue to observe all precautions during that
period.
     * To prevent oversedation, avoid drinking alcoholic beverages while
taking this medication.
     * If this medication makes you dizzy or drowsy, do not take part in any
activity that requires alertness, such as driving a car or operating
potentially dangerous machinery.  Be careful on stairs, and avoid getting up
suddenly from a lying or sitting position.
     * Prior to having surgery or any other medical or dental treatment, be
sure to tell your doctor or dentist that you are taking this medication.
     * This medication can decrease sweating and heat release from the body.
You should, therefore, try not to get overheated (avoid exercising strenuously
in hot weather and taking hot baths, showers, and saunas).
     * Do not stop taking this medication suddenly.  If the drug is stopped
abruptly, you may experience nausea, vomiting, stomach upset, headache,
increased heart rate, insomnia, tremors, or a worsening of your condition.
Your doctor may, therefore, want to reduce the dosage gradually.
     * If you are planning to have a myelogram, or any other procedure in
which dye will be injected into your spinal cord, tell your doctor that you
are taking this medication.
     * While taking this medication, do not take any over-the-counter
(nonprescription) medication for weight control or for cough, cold, asthma,
allergy, or sinus problems without first checking with your doctor.  The
combination of these medications with perphenazine and amitriptyline may cause
high blood pressure.
     * Be sure to tell your doctor if you are pregnant.  Small amounts of this
medication cross the placenta.  Although there are reports of safe use of this
drug during pregnancy, there are also reports of liver disease and tremors in
newborn infants whose mothers received this type of medication close to term.
Also, tell your doctor if you are breast-feeding an infant.  Small amounts of
this medication pass into breast milk and may cause unwanted effects in the
nursing infant.

----------------

The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
