Side Effects of Triavil

Triavil is a combination of amitriptyline, an older generation antidepressant, and perphenazine, an antipsychotic medication. It's used to treat patients who have a combination of depression and psychosis, including patients with schizophrenia who exhibit symptoms of depression. Side effects of triavil are a combination of the side effects of its two components.

Cardiac Effects

Amitriptyline and perphenazine, either alone or in combination, can lead to fatal disturbances in the heart rhythm. The risk is greater in patients with existing heart disease and certain genetic conditions. Amitriptyline can also cause orthostatic hypotension, a drop in blood pressure when standing up. In elderly people this could lead to falls and fractures. Triavil should be avoided in patients with coronary artery disease.

Suicide Risk

The Food and Drug Administration has issued a black box warning stating that antidepressants of all types, including amitriptyline, may cause an increase in suicidal thoughts and behavior. The risk is greater when starting treatment. The increase in suicidality appears in patients who are given antidepressants for any indication. The FDA states that there is some indication that increased anxiety, sleeplessness and agitation are all related to development of suicidal thoughts with antidepressants.

Anticholinergic Side Effects

Amitriptyline has a strong anticholinergic effect, meaning it blocks cholinergic receptors. As a result, it causes dry mouth, blurry vision, constipation and difficulty urinating. According to Merck.com, its use is contraindicated in men with enlarged prostates. Amitriptyline may precipitate acute angle-closure glaucoma, which can lead to blindness.

Neurological Side Effects

According to "Kaplan and Sadock's Comprehensive Textbook of Psychiatry," perphenazine, when used alone or as part of a combination drug, can cause both acute and long-term neurological side effects. Acute effects include akathisia, which is severe restlessness, and tremor that resembles a parkinsonian tremor. Acute dystonia, a sudden rigidity of muscles, can occur anywhere in the body. If it occurs in the jaw, the patient won't be able to open his mouth. It can lead to closure of the vocal cords, inability to breathe and death. Long-term side effects include tardive dyskinesia, which is a debilitating movement disorder that consists of constant movements that are not under conscious control—mainly of the lips and tongue.