A combination is graded by its riskiest ingredient: each part of the score is the lowest of the ingredients' scores. This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.
Each ingredient has its own full page with the FDA label, side-effect reports, recalls, evidence, and payments. Open them for the detail behind this grade.
Score breakdown (71/100)
Safety ×35%
D
Evidence ×25%
F
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
A
Safety: 61
Graded by its riskiest ingredient, amitriptyline (61)
Carries an FDA boxed warning, the strongest warning the FDA issues (-30)
4,152 FDA reports naming it as the suspect drug per million Medicare fills, 1.5x the median drug on this site (-4)
Death share in reports is near or below the FAERS average (1.1x)
Off-label use is among the five most-reported items: widely used beyond its approved evidence (-5)
Evidence: 38
Graded by its riskiest ingredient, perphenazine (38)
43 randomized trials and 6 systematic reviews/meta-analyses indexed in PubMed
5 independent Cochrane review(s) exist
Only 38% of completed registered trials posted results (-8)
'Drug ineffective' is the single most-reported item about this drug in FAERS (-5)
Regulatory history: 100
Graded by its riskiest ingredient, amitriptyline (100)
Recalls since 2016: 0 Class I, 0 Class II, 1 Class III across 77 generic makers (-0)
Money & lawsuits: 100
Graded by its riskiest ingredient, amitriptyline (100)
Pharma paid doctors $0 tied to this drug last year: negligible
Not named in any pending federal MDL
Options: 100
Graded by its riskiest ingredient, amitriptyline (100)
Generic versions approved (77 applications)
18 same-class alternatives exist
Money and lawsuits
In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this combination's brands across 0 transactions.
No pending federal MDL names this combination or its brands.
The ingredients' own payments and lawsuits are on their pages and already count toward this grade.
Who takes it and what it costs
823Medicare Part D patients (2024)
3,570prescriptions filled
$123average cost per fill
$0Mtotal Medicare spend
Questions to ask your prescriber
This is a fixed combination of amitriptyline and perphenazine. Why both together, instead of only the one I need?
This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?
The most-reported problems in FDA's adverse event data are fatigue, nausea. How would we recognize and handle those?
Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
Why this one over amineptin, amoxapine, butriptyline? What would make you pick one of those instead?
What result are we expecting, by when, and what is the plan if it does not happen?
If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)
The most-reported problems in FDA's adverse event data are toxicity to various agents, weight increased. How would we recognize and handle those?
Why this one over acetophenazine, fluphenazine, perazine? What would make you pick one of those instead?