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Antidepressants, such as perphenazine/amitriptyline, are commonly prescribed for treating depression and other mental health disorders. While these medications offer significant benefits, they also pose certain risks. Below are important safety warnings and precautions to consider:

• Increased Risk for Younger Users: Individuals under 25 years old may experience worsening depression, increased suicidal thoughts, or unusual behavioral changes, particularly when starting treatment or adjusting the dose.
• Risks for Older Adults with Dementia: Older adults, particularly those over 65 with dementia-related psychosis, are at a higher risk of serious side effects and increased mortality when using these medications.
• Bipolar Disorder Precaution: Antidepressants should not be used alone in individuals with bipolar disorder, as they may trigger manic episodes.
• Movement Disorders: Long-term or high-dose use can lead to movement problems such as involuntary twitching, more common in older females.
• Neuroleptic Malignant Syndrome (NMS): This rare but serious condition requires immediate medical attention if symptoms like high fever, muscle stiffness, or confusion occur.
• Fall Risk: The medication may cause drowsiness and low blood pressure, increasing the risk of falls, especially in older adults.
• Blood Cell Count Issues: There is a potential for reduced white blood cell counts, increasing infection risk, particularly in those with pre-existing conditions.
• Cardiovascular Concerns: High doses may lead to heart rhythm problems, stroke, or heart attack.
• Seizure Risk: Those with a history of seizures should consult their doctor, as the medication may elevate seizure risk.
• Glaucoma: The medication can worsen angle-closure glaucoma, so any vision changes should be reported.

Contraindications:

• Avoid use if experiencing slowed brain activity due to sedatives or similar substances.
• Not recommended for individuals with recent heart attacks, low blood cell counts, or those who have recently used MAOIs.

In case of overdose or severe side effects, seek emergency medical assistance immediately. Always discuss the risks and benefits of this medication with your healthcare provider to determine the most appropriate treatment plan.

Common side effects:

• drowsiness
• dizziness
• dry mouth
• blurred vision
• constipation
• tiredness

Less common but important to monitor:

• headaches
• nausea
• vomiting
• sweating
• itching
• skin rash
• changes in weight
• restlessness
• tremors
• uncontrolled body movements
• unwanted breast milk production
• menstrual changes
• decreased sexual ability

Serious side effects:

• muscle stiffness
• severe confusion
• rapid heartbeat
• dark urine
• signs of a stroke
• chest pain
• irregular heartbeat
• tardive dyskinesia
• neuroleptic malignant syndrome
• serious allergic reaction

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine)
• Bepridil
• Cisapride
• Dronedarone
• Droperidol
• Grepafloxacin
• Furazolidone
• Mesoridazine
• Pimozide
• Piperaquine
• Ranolazine
• Sparfloxacin
• Terfenadine
• Thioridazine
• Ziprasidone

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Amiodarone
• Quinidine
• Erythromycin
• Ketoconazole
• Fluoxetine
• Paroxetine
• Cimetidine
• Rifamycins
• Anti-HIV drugs
• Aspirin
• Nortriptyline

Interactions with low risk that usually do not require a change in therapy:

• Alcohol
• Marijuana (cannabis)
• Alprazolam
• Lorazepam
• Zolpidem
• Cetirizine
• Diphenhydramine
• Codeine
• Hydrocodone