A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Trilafon Overdose, Contraindications and Information - Perphenazine
Trilafon Overdose, Contraindications and Information - Perphenazine
OVERDOSE
In the event of overdosage, emergency treatment should be started immediately.
All patients suspected of having taken an overdose should be hospitalized
as soon as possible.
Manifestations
Overdosage of perphenazine primarily involves the extra-pyramidal mechanism
and produces the same side effects described under ADVERSE
REACTIONS, but to a more marked degree. It is usually evidenced
by stupor or coma; children may have convulsive seizures.
Treatment
Treatment is symptomatic and supportive. There is no specific antidote.
The patient should be induced to vomit even if emesis has occurred spontaneously.
Pharmacologic vomiting by the administration of ipecac syrup is a preferred
method. It should be noted that ipecac has a central mode of action in
addition to its local gastric irritant properties, and the central mode
of action may be blocked by the antiemetic effect of perphenazine tablets.
Vomiting should not be induced in patients with impaired consciousness.
The action of ipecac is facilitated by physical activity and by the administration
of 8 to 12 fluid ounces of water. If emesis does not occur within 15 minutes,
the dose of ipecac should be repeated. Precautions against aspiration
must be taken, especially in infants and children. Following emesis, any
drug remaining in the stomach may be adsorbed by activated charcoal administered
as a slurry with water. If vomiting is unsuccessful or contraindicated,
gastric lavage should be performed. Isotonic and one-half isotonic saline
are the lavage solutions of choice. Saline cathartics, such as milk of
magnesia, draw water into the bowel by osmosis and therefore, may be valuable
for their action in rapid dilution of bowel content.
Standard measures (oxygen, intravenous fluids, corticosteroids) should
be used to manage circulatory shock or metabolic acidosis. An open airway
and adequate fluid intake should be maintained. Body temperature should
be regulated. Hypothermia is expected, but severe hyperthermia may occur
and must be treated vigorously. (See CONTRAINDICATIONS
.)
An electrocardiogram should be taken and close monitoring of cardiac
function instituted if there is any sign of abnormality. Cardiac arrhythmias
may be treated with neostigmine, pyridostigmine, or propranolol. Digitalis
should be considered for cardiac failure. Close monitoring of cardiac
function is advisable for not less than five days. Vasopressors such as
norepinephrine may be used to treat hypotension, but epinephrine should
NOT be used.
Anticonvulsants (an inhalation anesthetic, diazepam, or paraldehyde)
are recommended for control of convulsions, since perphenazine increases
the central nervous system depressant action, but not the anticonvulsant
action of barbiturates.
If acute parkinson-like symptoms result from perphenazine intoxication,
benztropine mesylate or diphenhydramine may be administered.
Central nervous system depression may be treated with nonconvulsant doses
of CNS stimulants. Avoid stimulants that may cause convulsions (e.g.,
picrotoxin and pentylenetetrazol).
Signs of arousal may not occur for 48 hours.
Dialysis is of no value because of low plasma concentrations of the drug.
Since overdosage is often deliberate, patients may attempt suicide by
other means during the recovery phase. Deaths by deliberate or accidental
overdosage have occurred with this class of drugs.
CONTRAINDICATIONS
Perphenazine tablets are contraindicated in comatose or greatly obtunded
patients and in patients receiving large doses of central nervous system
depressants (barbiturates, alcohol, narcotics, analgesics, or antihistamines);
in the presence of existing blood dyscrasias, bone marrow depression,
or liver damage; and in patients who have shown hypersensitivity to perphenazine
tablets, their components, or related compounds.
Perphenazine tablets are also contraindicated in patients with suspected
or established subcortical brain damage, with or without hypothalamic
damage, since a hyperthermic reaction with temperatures in excess of 104°F
may occur in such patients, sometimes not until 14 to 16 hours after drug
administration. Total body ice-packing is recommended for such a reaction;
antipyretics may also be useful.
top
