How Perazine works
Perazine has a depressant, antianxiety, and antipsychotic effect (i.e., against psychotic symptoms such as delusions and hallucinations). In addition, the active ingredient facilitates falling asleep and prevents nausea and vomiting (antiemetic effect).
Psychotic symptoms, agitation and anxiety.
Perazine triggers these effects by blocking binding sites (receptors) of so-called neurotransmitters. These are messenger substances responsible for signal transmission between nerve cells.
One of these messenger substances is dopamine. According to experts, an increased concentration of it in the brain is associated with disturbed perception of the environment, delusions and hallucinations.
Thus, in some mental illnesses, excessive dopamine is found primarily in the limbic system. This part of the brain is responsible for emotions such as fear and anger, among others.
Perazine blocks the binding sites of dopamine as well as those of serotonin. Both messenger substances are then unable to dock and exert their effect. This normalizes an imbalance of neurotransmitters in the brain. Perazine thus counteracts states of restlessness, feelings such as anxiety, and delusions and hallucinations.
Nausea and vomiting
Blocking them prevents messenger substances from binding that would otherwise trigger nausea and vomiting in this way.
Sleep
The blockade of histamine receptors in the brain is the reason why perazine can help with sleep disorders. The neurotransmitter histamine affects the sleep-wake rhythm and triggers wakefulness (it is also known for its involvement in allergic reactions). By inhibiting histamine action, Perazine helps patients fall asleep more easily.
Unintended effects
The active ingredient also blocks other receptors of endogenous messenger substances. These include muscarinic receptors (binding sites of acetylcholine) and alpha-1 adrenoceptors (binding sites of epinephrine and norepinephrine).
Blockade of these receptors mainly explains undesirable effects of perazine. Read more about this in the side effects section!
Perazine: onset of action
Perazine effects occur at different rates after the onset of intake. Perazine has an immediate sedative, antianxiety, and depressant effect. In contrast, it usually takes one to three weeks for psychotic symptoms to improve.
What are the side effects of Perazine?
By blocking dopamine receptors, Perazine can cause so-called extrapyramidal motor side effects:
After prolonged use, more severe extrapyramidal motor disturbances are possible. Symptoms similar to those of Parkinson’s disease occur. Doctors refer to this as Parkinsonoid:
Patients are shaky or find it difficult to perform fine-tuned movements (e.g., buttoning a shirt). In severe cases, those affected can barely sit still or can no longer control some muscle groups at will. These symptoms, which are referred to by doctors as tardive dyskinesia, may also occur only after the patient has stopped taking perazine.
Tell your doctor immediately if you notice any movement problems. He or she will then reduce your Perazine dose or prescribe a medication to treat the symptoms. Early dyskinesias are usually easily treatable, whereas tardive dyskinesias are often irreversible.
Especially at the beginning of therapy, patients often suffer from the depressant effect of perazine: fatigue and drowsiness set in. The depressant effect can be more pronounced, especially in elderly patients. This increases the risk of falling.
Refrain from driving vehicles (such as cars) or operating machinery, especially during the first few days of therapy.
A rare but dangerous side effect of perazine is prolongation of the so-called QT time. This is a certain period of time in the heart current curve (ECG). This side effect may result in dangerous cardiac arrhythmias, for example torsades de pointes tachycardia, especially in patients with heart disease.
If you feel your heartbeat is getting out of sync during treatment with Perazine, you should contact a health care provider immediately and get checked.
Perazine may cause anticholinergic side effects (by inhibiting acetylcholine action), especially in higher doses. Often these include nasal congestion, dry mouth, and increased intraocular pressure. Less commonly, constipation or problems with urination develop.
Such anticholinergic side effects often occur more frequently, especially in older people. The reason is that with increasing age, both the number of acetylcholine binding sites in the brain and the number of acetylcholine-producing nerve cells decrease.
So older people are generally deficient in acetylcholine. If they then also take perazine, which blocks the few remaining receptors of the neurotransmitter, anticholinergic effects can increase.
Liver enzyme levels in the blood often rise during treatment with perazine.
Perazine makes the skin more sensitive to light. Therefore, protect your skin from UV rays, for example with sunscreen and long-sleeved clothing. It is also advisable to avoid direct sunlight and tanning sessions.
Antipsychotics such as Perazine occasionally increase the risk of malignant neuroleptic syndrome. This rare but life-threatening side effect requires immediate medical attention! Possible signs of malignant neuroleptic syndrome include high fever, stiff muscles, and impaired consciousness (such as confusion).
For additional information on possible unwanted side effects, see the package insert for your Perazine medication. Contact your doctor or pharmacist if you notice or suspect any other side effects.
When is Perazine used?
Several mental health conditions are approved uses for Perazine, such as:
- Acute psychotic disorders with delusions, hallucinations, thinking and ego disorders.
- movement disorders in the context of mental illnesses (especially excessive movements)
- chronic mental disorders
- pathologically increased mood states and high emotions (manifest syndromes)
Occasionally, physicians prescribe patients low-dose Perazine for sleep, namely for mental illnesses in connection with sleep disorders. This is also not an official indication for Perazine. However, other active ingredients from the group of antipsychotics, such as quetiapine, are more suitable as sleep aids in this case.
The use of antipsychotics such as Perazine against depression is not common, but is only considered in certain cases – for example, when depressed people suffer from persistent sleep disorders or also show psychotic features (such as delusions).
How to use perazine properly?
Perazine is available in tablet form. Patients take them unchewed with sufficient liquid.
Tapering in and out of therapy
As a rule, therapy starts with low doses of the active ingredient. Doctors then slowly increase these doses until a sufficient effect is achieved against the existing symptoms. In this way, the smallest effective dose of Perazine can be found for each patient.
To end the therapy after a long period of use, the procedure is also slow (“creeping out”): The doctor reduces the dose in small steps. This allows the body to be slowly weaned off the active substance and weaning symptoms can be avoided.
Perazine: Dosage
Generally, patients with acute mental illness take 50 to 150 milligrams of Perazine at the beginning. If the dose is not sufficient, doctors increase the amount up to a maximum of 500 milligrams of Perazine.
After the acute phase of the mental illness has subsided, physicians prescribe up to 300 milligrams of Perazine per day to prevent a relapse of the illness (maintenance therapy). If the patient is hospitalized, higher dosages are sometimes given (up to 1000 milligrams daily).
For patients with chronic mental illness, perazine dosing is generally up to 75 to 600 milligrams per day.
Some patients are prescribed a reduced dose by physicians. This applies, for example, to people with impaired liver function (slower perazine breakdown) and to the elderly (who are usually more sensitive to the active substance).
Other important information about Perazine
Antipsychotics such as Perazine do not usually lead to dependence – even after prolonged use. However, because they can sometimes cause severe side effects, patients should take strict care to take antipsychotics exactly as prescribed.
Those who misuse Perazine (for example, as a drug and without an existing mental illness) are usually tired, unhappy or in a bad mood.
So after an overdose there is only a short window of time in which you can rinse the stomach of the affected person and thus get out the swallowed tablets before the active substance is absorbed.
Take Perazine only if your health care provider has prescribed it for you. Stick to the prescribed dosage and use and do not increase the dose on your own.
When should you not use Perazine?
Perazine medication should not be taken under the following circumstances:
- Hypersensitivity to the active ingredient perazine or other ingredients of the medication.
- hypersensitivity to other antipsychotics, especially those with a similar structure to perazine (e.g., phenothiazine-type agents)
- severe blood cell or bone marrow damage
In certain cases, physicians must carefully consider whether they can administer perazine to patients. For example:
- if an antipsychotic has already triggered a malignant neuroleptic syndrome once before
- @ in cases of acute intoxication with alcohol or centrally depressant drugs (e.g., antidepressants, sleeping pills, or opioid pain relievers)
- in tumors whose growth is promoted by prolactin (e.g. breast cancer)
- if blood pressure deviates greatly from normal values (high blood pressure or low blood pressure)
- if there is a history of seizures or epilepsy
- in case of simultaneous use of certain drugs (read more in the section Interactions!)
These drug interactions may occur with Perazine
Some medicines have similar effects to Perazine. The effects and side effects may then become more noticeable. Such medicines include:
- centrally depressant drugs: sleeping pills and opioid painkillers increase the depressant effect of Perazine, possibly also on breathing (respiratory depression)!
- Antihypertensive drugs: In combination with Perazine, blood pressure drops even further. Possible consequences include dizziness.
- anticholinergic drugs: they increase the anticholinergic side effects of perazine (e.g. constipation). Examples include Parkinson’s disease medications.
- Lithium: The drug may help with bipolar disorder. However, it increases extrapyramidal motor side effects such as movement disorders.
- QT time-prolonging drugs: When combined with perazine, the risk of cardiac arrhythmias increases. Examples include macrolide antibiotics (such as erythromycin) and some antimalarial drugs.
The concomitant use of such drugs with perazine is carefully weighed by medical professionals.
Refrain from alcohol during Perazine therapy!
Perazine may increase the amount of active ingredients of other medicines in the blood. This applies, for example, to clozapine (used to treat schizophrenia) and tricyclic antidepressants (such as amitriptyline). The doctor then reduces their dose to avoid an overdose.
Some drugs affect the enzyme that breaks down perazine in the body. For example, estrogens, such as those found in the contraceptive pill, can inhibit the enzyme. As a result, perazine is broken down more slowly, increasing its effects and side effects.
Conversely, tobacco smoke increases the degradation of perazine in heavy smokers. The dose taken may then no longer be sufficient to adequately relieve symptoms.
Tell your doctor and pharmacist about any other medicines or dietary supplements you are taking. This includes over-the-counter as well as herbal preparations. For more information about drug interactions, see the package insert for your Perazine medication.
Perazine in children: What should be considered?
The use of Perazine in children and adolescents under 16 years of age has not been adequately studied. Therefore, the drug should not be used in this patient group.
Perazine during pregnancy and lactation
The use of Perazine during pregnancy and lactation has been little studied.
If pregnant women take perazine towards the end of pregnancy, the child may show so-called extrapyramidal symptoms and/or withdrawal symptoms after birth. These may include tremors, stiff or flaccid muscles, drowsiness, restlessness, shortness of breath or problems with breastfeeding.
Perazine passes into breast milk. Patients who are breastfeeding should not take Perazine. If it is absolutely necessary to use it, doctors will decide on a case-by-case basis whether a woman should wean beforehand.
If you are taking Perazine and you (want to) become pregnant, you should contact your doctor. You may need to switch to a more appropriate medication, such as quetiapine.
How to get medicines with perazine
There are currently no perazine medicines registered in Austria and Switzerland.
In Germany, medicines with perazine are available by prescription. Patients can obtain them from pharmacies with a doctor’s prescription.
