Leukopenia, neutropenia, and agranulocytosis

The experts of this site told us of leukopenia/neutropenia and agranulocytosis temporarily associated with antipsychotics have been reported in clinical trials and postmarketing experience.

Possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell counts and a history of drug-induced leukopenia/neutropenia. Patients with a pre-existing low white blood cell count or a history of leukopenia/neutropenia should have their total blood count (TBC) monitored frequently during the first few months of therapy and should discontinue USP Adepsique (Perphenazine) at the first sign of decreased levels. WBC in the absence of other causative factors.

Patients with neutropenia should be closely monitored for fever or other symptoms or signs of infection and treated immediately if such symptoms or signs appear. Patients with severe neutropenia (absolute neutrophil count <1000 / mm 3 ) should discontinue Adepsique (Perphenazine) USP tablets and monitor white blood cell counts until recovery.

The possibility of suicide in depressed patients persists during treatment and until significant remission occurs. Patients of this type should not have access to large amounts of this drug.

Like all phenothiazine compounds, Adepsique (Perphenazine) should not be used indiscriminately. Caution should be exercised when prescribing it to patients who have had previous severe adverse reactions to other phenothiazines. Some of the adverse effects of Adepsique (Perphenazine) tend to occur more frequently when using high doses. However, as with other phenothiazine compounds, patients receiving Adepsique (Perphenazine) in any dosage should be closely monitored.

Antipsychotic drugs increase prolactin levels; the increase persists with chronic administration. Tissue culture experiments show that approximately one-third of human breast cancers are prolactin-dependent in vitro. Although abnormalities such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported, the clinical significance of elevated serum prolactin levels in most patients is unknown. Increased mammary neoplasms have been found in rodents after long-term administration of antipsychotic drugs. However, neither clinical nor epidemiologic studies to date have shown an association between chronic ingestion of these drugs and breast oncogenesis; the available evidence is currently considered too limited to be definitive.

The antiemetic effect of Adepsique (Perphenazine) may mask signs of toxicity due to overdose of other medications or make it difficult to diagnose conditions such as brain tumors or intestinal obstruction.

Significant, unexplained increases in body temperature may indicate individual intolerance to Adepsique (Perphenazine), in which case it should be discontinued.

Patients taking high doses of phenothiazine who have undergone surgery should be closely monitored for possible hypotensive events. Moreover, fewer anesthetics or central nervous system depressants may be required.

Because phenothiazines and central nervous system depressants (opiates, analgesics, antihistamines, barbiturates) may potentiate each other’s effects, a smaller than usual dose of the drug to be added is recommended, and caution is advised when using them concomitantly.

Use with caution in patients receiving atropine or related drugs because of additional anticholinergic effects, and in patients who will be exposed to extreme heat or phosphorus insecticides.

Alcohol should be avoided because additive effects and hypotension may occur. Patients should be warned that their reaction to alcohol may increase during treatment with Adepsique (Perphenazine). The risk of suicide and the risk of overdose may be increased in patients who drink excessive amounts of alcohol because of the potentiating effects of the drug.

Blood counts and liver and kidney function should be checked periodically. The appearance of signs of blood dyscrasias requires withdrawal of the drug and prescription of appropriate therapy. If abnormal hepatic test results are found, treatment with phenothiazine should be discontinued. Renal function should be monitored in patients receiving long-term therapy; If blood urea nitrogen (BUN) levels become abnormal, treatment should be discontinued.

Phenothiazine derivatives should be used with caution in patients with impaired renal function.

Use with caution in patients with respiratory impairment due to acute lung infections or chronic respiratory conditions such as severe asthma or emphysema.

In general, phenothiazines, including Adepsique (Perphenazine), do not cause psychiatric dependence. Gastritis, nausea and vomiting, dizziness, and tremor have been reported after abrupt discontinuation of high-dose therapy. Reports suggest that these symptoms can be reduced by continuing to take concomitant anti-Parkinsonian medications for several weeks after phenothiazine withdrawal.

With long-term treatment, be aware of the possibility of liver damage, corneal and lenticular deposits, and irreversible dyskinesias.

Because photosensitivity has been reported, excessive sun exposure should be avoided during phenothiazine treatment.