Perphenazine: uses and side effects of this antipsychotic

One of the best-known types of mental disorder is that of psychotic disorders. This type of disorder, considered a serious mental disorder, generates a high level of suffering for those who suffer from it and those around them.

The typical symptoms of this type of disorder, among which schizophrenia and the disorder schizoaffective, can be very disabling and greatly alter the quality of life of those who suffer from it if they do not receive treatment. In addition to that, It is one of the types of mental disorder with the highest level of social stigmatization, something that makes the situation of those who suffer from it even more difficult.

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

• Related article: "Types of antipsychotics (or neuroleptics)"

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 symptoms, which works by reducing the level of activity of certain neurotransmitters.

It is considered a medium potency antipsychotic, being much more powerful (it is estimated that up to five times more) than chlorpromazine and being especially effective in the treatment of positive symptoms (that is, those that are added to the normal functioning of patients such as hallucinations and delusions, disorganized behavior or agitation).

Among the antipsychotics, perphenazine is classified as one of the typical or classic antipsychotics, which, although they are very useful in the treatment of the aforementioned symptoms, do not have great effect on negative symptomatology (symptoms that reduce the functionality and capabilities of the subject, such as the abulia or poverty of thought), and could even cause a worsening).

In addition to this, they can lead to the appearance of considerably annoying and disabling secondary symptoms, these two factors being elements that came together in which research continued towards a more favorable mechanism of action and that would lead to the generation of atypical or second-generation antipsychotics.

This is not to say that perphenazine and other typical antipsychotics are not used in clinical practice, but not usually the first therapeutic option and it is usually used when other drugs are not effective.

• You may be interested in: "Types of psychoactive drugs: uses and side effects"

Mechanism of action

Like most antipsychotics, the main mechanism of action of perphenazine is through its action on the dopamine cerebral. Specifically, perphenazine works by blocking dopamine D2 receptors in the brain.

And it has been observed that patients with schizophrenia or other psychotic disorders often have excess dopamine in the mesolimbic pathway, an excess that has been seen to be related to positive symptoms. In this way, perphenazine blocks the dopamine receptors of this pathway at the postsynaptic level, making its activity on this region less and reducing agitation and symptomatology positive.

However, the action of perphenazine is not selective: blockade of D2 receptors 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 symptoms (apathy, apathy, etc.) have been linked to a deficit of this substance in the pathway mesocortical, in such a way that the action of perphenazine would not help to solve this type of symptoms or could even aggravate them. This causes different side effects to appear depending on the pathway that suffers an unnecessary decrease in its dopamine levels, something that can alter aspects as diverse as motor skills, sexuality or systems as diverse as motor, sexual or sleep.

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

Main indications

The main indication for perphenazine, as the antipsychotic that it is, is for schizophrenia treatment. In this sense, it is especially effective in the treatment of positive symptoms such as those mentioned above. 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 to this, in some cases perphenazine is used as an antiemetic, allowing control of vomiting and nausea in patients with serious 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 useful drug, but Like other drugs, it has a large number of possible side effects. of great relevance. And it is that as we have said before, perphenazine can cause different annoying side effects in different nervous pathways, which in turn can alter various body systems.

Some of the different secondary symptoms that can occur are drowsiness, the appearance of headaches, dizziness and blurred vision, dryness or excessive salivation, the appearance of parkinsonian symptoms such as tremors, spasms and involuntary movements such as those 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 gender) and gynecomastia.

Sleep problems, despite the existence of drowsiness, are also possible, as are problems urinary (excess or defect), jaundice and the appearance of agitation and decreased ability to express facial. Likewise, it is also possible that it generates increased sensitivity to sunlight, fever, skin rashes, dark urine, leukopenia, thrombocytopenia or priapism.

More serious symptoms may be confusion, the possible occurrence of arrhythmias and bradycardia, hyperthermia, seizures and even neuroleptic malignant syndrome (a dangerous syndrome that can lead to the death of the patient, being one of the reasons that leads to the need for precise control of the dosage).

contraindications

In addition to the above, it must be taken into account that this drug is contraindicated for some sectors of the population, or its use must be carefully assessed. Among them are all those people who have suffered brain injuries, liver or kidney diseases, seizures seizures, major depression, breathing problems, or heart or cardiovascular problems (especially in the case of heart attack previous). In addition, is contraindicated for those who have had pheochromocytoma (tumor of the adrenal medulla).

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