Perphenazine: uses and side effects of this antipsychotic drug

This drug is mainly used to treat schizophrenia.

One of the best known types of mental disorders is psychotic disorders. This type of disorder, which is considered a serious mental disorder, causes a high level of suffering to the sufferer and his or her environment.

The typical symptoms of this type of disorder, among which schizophrenia and schizoaffective disorder stand out, can be very disabling and greatly alter the sufferer's quality of life if not treated. In addition, it is one of the most common types of schizophrenia and schizoaffective disorder, it is one of the types of mental disorder with the highest level of social stigmatization, which makes it even more difficult to treat.This makes the sufferer's situation even more difficult.

Fortunately, there are different treatments that facilitate the management and maintain the stability of patients, among which pharmacological treatment stands out. It is possible to find a wide variety of antipsychotic or neuroleptic drugs. One of them is perphenazineof which we are going to talk about in this article.

Perphenazine: a typical antipsychotic

Perphenazine is one of several drugs that are part of the group of antipsychotics or neuroleptics. It is a psychoactive substance highly effective in the treatment of psychotic symptomatology.It acts by reducing the level of activity of certain neurotransmitters.

It is considered a medium potency antipsychotic, being considerably more potent (estimated to be up to five times more potent) than chlorpromazine and being especially effective in the treatment of positive symptomatology (i.e., those that are added to the usual functioning of patients such as hallucinations and delusions, disorganized behavior or agitation).

Within the antipsychotics, perphenazine is classified as one of the typical or classical antipsychotics.Although they are very useful in the treatment of the aforementioned symptoms, they do not have a great effect on the negative symptomatology (symptoms that diminish the subject's functionality and capacities, such as abulia or poor thinking), and could even provoke an aggravation.)

In addition to this, they can lead to the appearance of considerably bothersome and disabling secondary symptoms, and these two factors led to further research into a more favorable mechanism of action, leading to the development of atypical or second-generation antipsychotics.

This does not mean that perphenazine and other typical antipsychotics are not used in clinical practice, but they are not usually the first therapeutic option. not usually the first therapeutic option and are usually used when other drugs are not effective.

Mechanism of action

Like most antipsychotics, the main mechanism of action of perphenazine is through its action on brain dopamine. Specifically, perphenazine acts by blocking the brain's dopamine D2 receptors.

It has been observed that patients with schizophrenia or other psychotic disorders usually have an excess of dopamine in the mesolimbic pathway, an excess that has been found to be related to positive symptomatology. Thus, perphenazine blocks the dopamine receptors of this pathway at the postsynaptic level, reducing its activity in this region and reducing agitation and positive symptomatology.

However, the action of perphenazine is not selective: D2 receptor blockade occurs not only in the mesolimbic pathway but also in other areas whose dopamine levels were not altered, or even in areas where some people have a deficit of this substance.

Specifically, negative symptomatology (abulia, apathy, etc.) has been linked to a deficit of this substance in the mesocortical pathway, so that the action of perphenazine would not help to solve this type of symptoms or could even aggravate them. This means that different side effects may appear depending on the pathway that suffers an unnecessary decrease in its dopamine levels, something that can alter aspects as diverse as motor function, sexuality, or systems as diverse or systems as diverse as motor, sexual or sleep.

In addition to the above, perphenazine also interacts with noradrenaline, histamine, serotonin and acetylcholine.

Main indications

The main indication for perphenazine, as an antipsychotic, is the treatment of schizophrenia. treatment of schizophrenia. In this sense it is especially effective in the treatment of positive symptoms such as the aforementioned hallucinations and delusions. It is especially useful in those patients with a high level of agitation (since it has sedative effects) and aggressiveness. Also in catatonic patients.

In addition, in some cases perphenazine is used as an antiemetic, allowing the control of vomiting and nausea in patients with severe problems and constant and dangerous emission of vomit. In some cases it can also be used in the treatment of manic episodes.

Side effects

Perphenazine is an effective and very useful drug, but, like all other drugs like all other drugs, it has a large number of possible side effects of great relevance. of great relevance. As mentioned above, perphenazine can cause different bothersome side effects in different nerve pathways, which in turn can alter various body systems.

Some of the different side symptoms that can occur are drowsiness, the occurrence of headaches, dizziness and blurred vision, dryness or excessive salivationThe appearance of Parkinsonian symptoms such as tremors, spasms and involuntary movements such as those characteristic of tardive dyskinesia. Weight gain, loss of appetite, diarrhea or constipation may also appear. Other possible symptoms are the appearance of arterial hypotension, hyperglycemia, loss of libido and the appearance of galactorrhea (regardless of sex) and gynecomastia.

Sleep problems, despite the existence of somnolence, are also possible, as well as urinary problems (due to excess or defect), jaundice and the appearance of agitation and decreased facial expression. Increased sensitivity to sunlight, fever, skin rashes, dark urine, leukopenia, thrombocytopenia or priapism are also possible.

More serious symptoms may include confusion, the possible occurrence of arrhythmias and bradycardias, hyperthermia, convulsions and even neurosyndrome.The use of these drugs can lead to confusion, convulsions and even neuroleptic malignant syndrome (a dangerous syndrome that can even lead to the death of the patient, being one of the reasons why a precise control of the dosage is required).

Contraindications

In addition to the above, it should be noted that some sectors of the population have contraindications to this drug, or its use should be carefully evaluated. These include all those who have suffered brain damage, liver or kidney disease, epileptic seizures, major depression, respiratory problems or heart or cardiovascular problems (especially in the case of previous infarction). It is also contraindicated it is also contraindicated for those who have had pheochromocytoma (tumor of the adrenal medulla).

Another sector of the population in which this drug is contraindicated is that of people with diabetes, since it tends to increase blood glucose levels. It is also necessary to take into account the possible interaction with other drugs and medicines, which can intensify or cancel out the effect of the drug with dangerous results for health. For example, its use is contraindicated with depressants such as alcohol and other drugs.. Elderly patients with dementia are also contraindicated, and it has been observed that in this type of patients the probability of death increases.