Perphenazine side effects: what 2,076 FDA adverse event reports show
Drug class
Phenothiazine
Who reports
2,076 reports · 83% serious · 222 with death outcome · 56% female
Used for
Perphenazine is indicated for use in the treatment of schizophrenia and for the control of severe nausea and vomiting in adults. Perphenazine has not been shown effective for the management of behavioral complications in patients with mental retardation.
What it is
DESCRIPTION Perphenazine (4-[3-(2-chlorophenothiazin-10-yl)propyl]-1-piperazineethanol), a piperazinyl phenothiazine, having the chemical formula, C 21 H 26 CIN 3 OS. It is available as oral tablets containing 2 mg, 4 mg, 8 mg and 16 mg of perphenazine.
Boxed warning
Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen place.
Causality screen of the 40 strongest signals
What the badges mean
- Labeled — boxed warning The term (or its clinical synonym) appears in the FDA boxed warning: causality is regulator-recognised and considered serious.
- Labeled adverse reaction The exact term appears in the label's warnings or adverse-reactions sections: a known, expected effect. The FAERS signal confirms the label rather than discovering anything.
- Labeled (related wording) The label describes this effect under different wording (e.g. 'neutropenia' for 'neutrophil count decreased'). Treated as known.
- Likely indication confounding The term appears in the label's indications: reports probably describe the disease being treated (or its progression), not a drug effect. Classic confounding by indication.
- Reporting / coding artifact An administrative, monitoring or exposure term (product issue, off-label use, 'test normal', overdose...). Not a biological reaction; a high PRR here reflects how reports are coded.
- Lab value / disease marker A laboratory result, investigation or disease-activity marker (antibody positive, CRP abnormal, swollen joint count) not described in the label. These usually mirror the monitored disease or testing protocol rather than a drug effect; not screened further.
- Outcome field, not a reaction Death is a report outcome, not a reaction term. It is dominated by the underlying illness; see the seriousness profile and the boxed warning instead.
- Not in label — unassessed Not found in the label text, not an artifact pattern. This is a genuine candidate for a formal causality assessment (Bradford Hill / WHO-UMC); it has NOT had one here.
Strongest disproportionality signals
Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 88 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Euphoric mood | 154 | 153.3 131.5–178.6ROR 165.5 · χ² 22,803 / p <1e-300 | 148.2 EB05 129.6 · IC025 +6.4 3/3 methods agree | Not in label — unassessed | serious n=154 · ♀ 1% (drug 56%) | no trial data cached |
| Akathisia (inner restlessness) | 186 | 139.6 121.5–160.2ROR 153.2 · χ² 25,112 / p <1e-300 | 135.7 EB05 120.1 · IC025 +6.4 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 134.3 · ♀ 9% (drug 56%) | no trial data cached |
| Leukaemia | 83 | 89.7 72.6–110.8ROR 93.4 · χ² 7,129 / p <1e-300 | 87.2 EB05 72.5 · IC025 +5.5 3/3 methods agree | Not in label — unassessed | serious PRR 62.0 · ♀ 0% (drug 56%) | no trial data cached |
| Parkinsonism | 85 | 88.8 72.0–109.5ROR 92.6 · χ² 7,231 / p <1e-300 | 86.4 EB05 72.0 · IC025 +5.5 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 68.9 · ♀ 89% (drug 56%) · 97% clinician | no trial data cached |
| Increased appetite | 156 | 84.5 72.6–98.4ROR 91.3 · χ² 12,696 / p <1e-300 | 83.0 EB05 72.6 · IC025 +5.8 3/3 methods agree | Labeled (related wording) related wording | serious PRR 149.7 · ♀ 3% (drug 56%) | no trial data cached |
| Obesity | 94 | 59.9 49.1–73.0ROR 62.6 · χ² 5,353 / p <1e-300 | 58.8 EB05 49.5 · IC025 +5.2 3/3 methods agree | Not in label — unassessed | serious PRR 45.8 · ♀ 10% (drug 56%) | no trial data cached |
| Neuroleptic malignant syndrome | 62 | 52.9 41.4–67.7ROR 54.5 · χ² 3,093 / p <1e-300 | 51.9 EB05 41.9 · IC025 +4.8 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 36.6 · 96% clinician | no trial data cached |
| Myoclonus | 61 | 51.9 40.5–66.5ROR 53.5 · χ² 2,983 / p <1e-300 | 50.9 EB05 41.1 · IC025 +4.8 3/3 methods agree | Not in label — unassessed | serious PRR 37.8 · ♀ 100% (drug 56%) · 98% clinician | no trial data cached |
| Blood calcium decreased | 50 | 45.0 34.2–59.2ROR 46.0 · χ² 2,097 / p <1e-300 | 44.1 EB05 34.7 · IC025 +4.5 3/3 methods agree | Lab value / disease marker | serious PRR 38.8 · ♀ 93% (drug 56%) · 94% clinician | no trial data cached |
| Dystonia | 86 | 44.8 36.4–55.2ROR 46.7 · χ² 3,628 / p <1e-300 | 44.2 EB05 36.9 · IC025 +4.8 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 33.3 · ♀ 95% (drug 56%) · 96% clinician | no trial data cached |
| Prescribed overdose | 76 | 39.8 31.9–49.7ROR 41.3 · χ² 2,829 / p <1e-300 | 39.3 EB05 32.4 · IC025 +4.6 3/3 methods agree | Not in label — unassessed | serious PRR 46.9 · ♀ 3% (drug 56%) | no trial data cached |
| Tardive dyskinesia (persistent involuntary movements) | 101 | 35.9 29.7–43.5ROR 37.7 · χ² 3,388 / p <1e-300 | 35.6 EB05 30.1 · IC025 +4.6 3/3 methods agree | Labeled — boxed warning exact term | serious PRR 28.1 · ♀ 91% (drug 56%) | no trial data cached |
| Orthostatic hypotension (dizziness on standing) | 59 | 34.3 26.6–44.1ROR 35.2 · χ² 1,867 / p <1e-300 | 33.8 EB05 27.2 · IC025 +4.3 3/3 methods agree | Not in label — unassessed | serious PRR 26.4 · ♀ 86% (drug 56%) · 95% clinician | no trial data cached |
| Cyst | 39 | 31.8 23.3–43.4ROR 32.4 · χ² 1,130 / p 6e-248 | 31.3 EB05 23.9 · IC025 +4.0 3/3 methods agree | Not in label — unassessed | serious PRR 28.8 · ♀ 97% (drug 56%) | no trial data cached |
| Suicide attempt | 181 | 30.2 26.2–34.7ROR 33.0 · χ² 5,076 / p <1e-300 | 30.0 EB05 26.5 · IC025 +4.6 3/3 methods agree | Not in label — unassessed | serious PRR 20.9 · ♀ 6% (drug 56%) | no trial data cached |
| Leukopenia (low white blood cells) | 140 | 28.4 24.2–33.4ROR 30.4 · χ² 3,675 / p <1e-300 | 28.2 EB05 24.5 · IC025 +4.4 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 20.4 · ♀ 1% (drug 56%) | no trial data cached |
| Sedation | 73 | 28.4 22.6–35.5ROR 29.4 · χ² 1,897 / p <1e-300 | 28.1 EB05 23.1 · IC025 +4.2 3/3 methods agree | Not in label — unassessed | serious PRR 24.8 · ♀ 77% (drug 56%) · 90% clinician | no trial data cached |
| Osteopenia | 40 | 26.5 19.5–36.1ROR 27.0 · χ² 956 / p 3e-210 | 26.2 EB05 20.1 · IC025 +3.8 3/3 methods agree | Not in label — unassessed | serious PRR 21.1 · ♀ 97% (drug 56%) | no trial data cached |
| Blood potassium increased | 38 | 23.7 17.3–32.5ROR 24.1 · χ² 803 / p 7e-177 | 23.4 EB05 17.8 · IC025 +3.7 3/3 methods agree | Lab value / disease marker | serious PRR 21.3 · ♀ 100% (drug 56%) | no trial data cached |
| Dyskinesia (involuntary movements) | 91 | 22.7 18.6–27.8ROR 23.7 · χ² 1,866 / p <1e-300 | 22.6 EB05 18.9 · IC025 +4.0 3/3 methods agree | Labeled — boxed warning exact term | serious PRR 20.7 · ♀ 91% (drug 56%) · 92% clinician | no trial data cached |
| Deformity | 21 | 22.7 14.8–34.7ROR 22.9 · χ² 413 / p 4e-92 | 22.2 EB05 15.3 · IC025 +3.2 3/3 methods agree | Not in label — unassessed | serious PRR 17.9 | no trial data cached |
| Extrapyramidal disorder | 55 | 22.2 17.1–28.8ROR 22.8 · χ² 1,091 / p 2e-239 | 22.0 EB05 17.5 · IC025 +3.8 3/3 methods agree | Labeled (related wording) related wording | serious PRR 16.1 · 94% clinician | no trial data cached |
| Therapeutic product effect incomplete | 144 | 20.6 17.6–24.1ROR 22.1 · χ² 2,671 / p <1e-300 | 20.5 EB05 17.9 · IC025 +4.0 3/3 methods agree | Reporting / coding artifact | serious PRR 26.6 · ♀ 4% (drug 56%) · 91% clinician | no trial data cached |
| Salivary hypersecretion | 19 | 19.2 12.3–30.1ROR 19.4 · χ² 310 / p 1e-69 | 18.8 EB05 12.5 · IC025 +2.9 3/3 methods agree | Not in label — unassessed | serious PRR 18.0 | no trial data cached |
| Toxicity to various agents | 285 | 17.2 15.4–19.1ROR 19.8 · χ² 4,354 / p <1e-300 | 17.1 EB05 15.5 · IC025 +3.9 3/3 methods agree | Labeled (related wording) related wording | serious PRR 12.2 · ♀ 30% (drug 56%) · 91% clinician | no trial data cached |
| Hallucination, auditory | 27 | 17.2 11.8–25.0ROR 17.4 · χ² 395 / p 4e-88 | 16.8 EB05 12.0 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious PRR 12.2 | no trial data cached |
| Depressed level of consciousness | 61 | 15.6 12.2–20.0ROR 16.1 · χ² 821 / p 7e-181 | 15.5 EB05 12.4 · IC025 +3.4 3/3 methods agree | Not in label — unassessed | serious PRR 11.1 · ♀ 94% (drug 56%) · 93% clinician | no trial data cached |
| Skin lesion | 39 | 14.5 10.6–19.8ROR 14.7 · χ² 476 / p 7e-106 | 14.2 EB05 10.7 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious PRR 14.0 · ♀ 97% (drug 56%) | no trial data cached |
| Bladder disorder | 14 | 14.2 8.4–24.0ROR 14.3 · χ² 159 / p 9e-37 | 13.1 EB05 7.5 · IC025 +2.4 3/3 methods agree | Labeled (related wording) related wording | serious n=14 | no trial data cached |
| Hypothermia | 13 | 13.0 7.5–22.3ROR 13.0 · χ² 132 / p 9e-31 | 11.6 EB05 6.5 · IC025 +2.2 3/3 methods agree | Not in label — unassessed | serious PRR 9.1 | no trial data cached |
| Mania | 21 | 12.9 8.4–19.8ROR 13.0 · χ² 219 / p 7e-50 | 12.2 EB05 8.0 · IC025 +2.6 3/3 methods agree | Not in label — unassessed | serious PRR 8.4 · ♀ 29% (drug 56%) | no trial data cached |
| Muscle rigidity | 15 | 12.7 7.7–21.0ROR 12.8 · χ² 150 / p 9e-35 | 11.5 EB05 6.8 · IC025 +2.3 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 9.2 | no trial data cached |
| Cognitive disorder | 58 | 12.6 9.8–16.3ROR 12.9 · χ² 609 / p 1e-134 | 12.4 EB05 9.8 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious PRR 12.2 · ♀ 88% (drug 56%) · 93% clinician | no trial data cached |
| Movement disorder | 39 | 12.2 9.0–16.7ROR 12.4 · χ² 391 / p 3e-87 | 11.8 EB05 8.8 · IC025 +2.9 3/3 methods agree | Labeled (related wording) related wording | serious PRR 10.5 · ♀ 95% (drug 56%) · 94% clinician | no trial data cached |
| Psychotic disorder | 35 | 12.0 8.6–16.6ROR 12.2 · χ² 341 / p 2e-76 | 11.5 EB05 8.4 · IC025 +2.8 3/3 methods agree | Labeled (related wording) related wording | serious PRR 8.0 | no trial data cached |
| Irritability | 68 | 11.4 9.0–14.4ROR 11.8 · χ² 637 / p 8e-141 | 11.2 EB05 9.0 · IC025 +3.0 3/3 methods agree | Not in label — unassessed | serious PRR 13.6 · ♀ 16% (drug 56%) | no trial data cached |
| Schizophrenia | 13 | 10.8 6.3–18.6ROR 10.9 · χ² 106 / p 4e-25 | 9.2 EB05 5.3 · IC025 +2.0 3/3 methods agree | Likely indication confounding term in indications | serious PRR 7.2 | no trial data cached |
| Completed suicide (death by suicide) | 88 | 10.6 8.6–13.0ROR 11.0 · χ² 755 / p 1e-166 | 10.4 EB05 8.6 · IC025 +3.0 3/3 methods agree | Outcome field, not a reaction boxed warning mentions mortality | serious PRR 7.2 · ♀ 33% (drug 56%) · 96% clinician | no trial data cached |
| Osteoarthritis | 44 | 10.5 7.8–14.0ROR 10.7 · χ² 368 / p 3e-82 | 10.0 EB05 7.6 · IC025 +2.7 3/3 methods agree | Not in label — unassessed | serious PRR 7.9 · ♀ 94% (drug 56%) | no trial data cached |
| Hepatomegaly | 10 | 10.2 5.5–19.0ROR 10.3 · χ² 74 / p 3e-18 | 8.1 EB05 4.3 · IC025 +1.8 3/3 methods agree | Not in label — unassessed | serious PRR 7.7 | no trial data cached |
Trial evidence (ClinicalTrials.gov)
Most frequently reported reactions
By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Toxicity to various agents | 285 | 17.2 15.4–19.1ROR 19.8 · χ² 4,354 / p <1e-300 | 17.1 EB05 15.5 · IC025 +3.9 3/3 methods agree | Labeled (related wording) related wording | serious PRR 12.2 · ♀ 30% (drug 56%) · 91% clinician | no trial data cached |
| Weight increased (weight gain) | 224 | 10.2 9.0–11.5ROR 11.3 · χ² 1,860 / p <1e-300 | 10.1 EB05 9.0 · IC025 +3.1 3/3 methods agree | Labeled (related wording) related wording | serious PRR 12.3 · ♀ 27% (drug 56%) | no trial data cached |
| Akathisia (inner restlessness) | 186 | 139.6 121.5–160.2ROR 153.2 · χ² 25,112 / p <1e-300 | 135.7 EB05 120.1 · IC025 +6.4 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 134.3 · ♀ 9% (drug 56%) | no trial data cached |
| Suicide attempt | 181 | 30.2 26.2–34.7ROR 33.0 · χ² 5,076 / p <1e-300 | 30.0 EB05 26.5 · IC025 +4.6 3/3 methods agree | Not in label — unassessed | serious PRR 20.9 · ♀ 6% (drug 56%) | no trial data cached |
| Product use in unapproved indication | 156 | 6.5 5.5–7.5ROR 6.9 · χ² 721 / p 3e-159 | 6.3 EB05 5.5 · IC025 +2.4 3/3 methods agree | Reporting / coding artifact | serious PRR 9.7 · 91% clinician | no trial data cached |
| Increased appetite | 156 | 84.5 72.6–98.4ROR 91.3 · χ² 12,696 / p <1e-300 | 83.0 EB05 72.6 · IC025 +5.8 3/3 methods agree | Labeled (related wording) related wording | serious PRR 149.7 · ♀ 3% (drug 56%) | no trial data cached |
| Euphoric mood | 154 | 153.3 131.5–178.6ROR 165.5 · χ² 22,803 / p <1e-300 | 148.2 EB05 129.6 · IC025 +6.4 3/3 methods agree | Not in label — unassessed | serious n=154 · ♀ 1% (drug 56%) | no trial data cached |
| Therapeutic product effect incomplete | 144 | 20.6 17.6–24.1ROR 22.1 · χ² 2,671 / p <1e-300 | 20.5 EB05 17.9 · IC025 +4.0 3/3 methods agree | Reporting / coding artifact | serious PRR 26.6 · ♀ 4% (drug 56%) · 91% clinician | no trial data cached |
| Leukopenia (low white blood cells) | 140 | 28.4 24.2–33.4ROR 30.4 · χ² 3,675 / p <1e-300 | 28.2 EB05 24.5 · IC025 +4.4 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 20.4 · ♀ 1% (drug 56%) | no trial data cached |
| Drug interaction | 131 | 8.3 7.1–9.9ROR 8.8 · χ² 845 / p 4e-186 | 8.2 EB05 7.1 · IC025 +2.7 3/3 methods agree | Reporting / coding artifact | serious PRR 6.5 · 91% clinician | no trial data cached |
| Tardive dyskinesia (persistent involuntary movements) | 101 | 35.9 29.7–43.5ROR 37.7 · χ² 3,388 / p <1e-300 | 35.6 EB05 30.1 · IC025 +4.6 3/3 methods agree | Labeled — boxed warning exact term | serious PRR 28.1 · ♀ 91% (drug 56%) | no trial data cached |
| Obesity | 94 | 59.9 49.1–73.0ROR 62.6 · χ² 5,353 / p <1e-300 | 58.8 EB05 49.5 · IC025 +5.2 3/3 methods agree | Not in label — unassessed | serious PRR 45.8 · ♀ 10% (drug 56%) | no trial data cached |
| Dyskinesia (involuntary movements) | 91 | 22.7 18.6–27.8ROR 23.7 · χ² 1,866 / p <1e-300 | 22.6 EB05 18.9 · IC025 +4.0 3/3 methods agree | Labeled — boxed warning exact term | serious PRR 20.7 · ♀ 91% (drug 56%) · 92% clinician | no trial data cached |
| Completed suicide (death by suicide) | 88 | 10.6 8.6–13.0ROR 11.0 · χ² 755 / p 1e-166 | 10.4 EB05 8.6 · IC025 +3.0 3/3 methods agree | Outcome field, not a reaction boxed warning mentions mortality | serious PRR 7.2 · ♀ 33% (drug 56%) · 96% clinician | no trial data cached |
| Overdose | 87 | 4.1 3.3–5.0ROR 4.2 · χ² 199 / p 1e-45 | 4.0 EB05 3.3 · IC025 +1.6 3/3 methods agree | Reporting / coding artifact | serious PRR 3.3 · ♀ 77% (drug 56%) | no trial data cached |
Unlabeled candidate signals
These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.
- Euphoric mood — n=154, PRR 153.3
- Leukaemia — n=83, PRR 89.7
- Obesity — n=94, PRR 59.9
- Myoclonus — n=61, PRR 51.9
- Prescribed overdose — n=76, PRR 39.8
- Orthostatic hypotension — n=59, PRR 34.3
- Cyst — n=39, PRR 31.8
- Suicide attempt — n=181, PRR 30.2
- Sedation — n=73, PRR 28.4
- Osteopenia — n=40, PRR 26.5
Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.
Common questions
What are the most reported side effects of Perphenazine?
In FDA FAERS, the most frequently co-reported reaction terms for Perphenazine are toxicity to various agents, weight increased, akathisia, suicide attempt, increased appetite, euphoric mood. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.
Does Perphenazine have an FDA boxed warning?
Yes. The current FDA label carries a boxed warning: Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen place.
Do FAERS signals prove that Perphenazine causes these side effects?
No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.
Sources & methods
- FDA label via openFDA (set ID 0ebf4c11-1810-42f6-a8e3-071616e33d5d, effective 20241212; matched on
openfda.generic_name.exact:"PERPHENAZINE") - Bayesian shrinkage measures computed offline over all 1,317,300 cached pairs: BCPNN information component (IC, with Norén closed-form IC025) and MGPS empirical-Bayes geometric mean (EBGM, EB05) with a two-component gamma prior fitted by maximum marginal likelihood (α₁=0.57, β₁=0.02, α₂=1.42, β₂=0.70, w=0.17); unstratified
- FAERS pair statistics from the OpenPV build of 2026-09-14 (openFDA
count=aggregation, fieldpatient.drug.openfda.generic_name.exact, 128 reaction terms, min 3 co-reports); PRR/ROR with 95% CI, chi-square with Yates correction - Serious-only and stratified counts (serious:1, patient.patientsex, primarysource.qualification) from openFDA count queries; serious-only PRR uses the drug serious report total and the term global serious total (N_serious=11,882,979); strata shown only when n ≥ 20
- Seriousness and sex counts from openFDA
count=serious,patient.patientsex,seriousnessdeath
Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.