Women are less likely to be symptomatic, and if symptomatic have less severe manifestations.Remaining variations in disease course are attributed to unknown environmental factors. A single study found that disease course is not worsened by tobacco smoking or alcohol consumption, common risk factors for other diseases. Pregnancy
Pregnancy outcomes are overall good in mothers with FSHD; there is no difference in rate of preterm labor, rate of miscarriage, and infant outcomes. However, weakness can increase the need for assisted delivery.A single review found that weakness worsens, without recovery, in 12% of mothers with FSHD during pregnancy, although this might be due to weight gain or deconditioning. Epidemiology
The prevalence of FSHD ranges from 1 in 8,333 to 1 in 15,000. The Netherlands reports a prevalence of 1 in 8,333, after accounting for the undiagnosed. The prevalence in the United States is commonly quoted as 1 in 15,000.After genetic testing became possible in 1992, average prevalence was found to be around 1 in 20,000, a large increase compared to before 1992. However, 1 in 20,000 is likely an underestimation, since many with FSHD have mild symptoms and are never diagnosed, or they are siblings of affected individuals and never seek definitive diagnosis.Race and ethnicity have not been shown to affect FSHD incidence or severity.Although the inheritance of FSHD shows no predilection for biological sex, the disease manifests less often in women, and even when it manifests in women, they on average are less severely affected than affected males.
Amitriptyline/perphenazine (Duo-Vil, Etrafon, Triavil, Triptafen) is a formulation that contains the tricyclic antidepressant amitriptyline and the medium-potency typical (first-generation) antipsychotic, perphenazine. In the United States amitriptyline/perphenazine is marketed by Mylan Pharmaceuticals Inc. and Remedy Repack Inc.

Medical uses
In the United States amitriptyline/perphenazine is indicated for the treatment of patients with:
Moderate-severe anxiety and/or agitation and depression
Depression and anxiety in association with chronic physical disease
Schizophrenia with prominent depressive symptoms

Adverse effects
Common (>1% incidence) adverse effects include
Sedation
Hypertension — high blood pressure. Neurological impairments (such as extrapyramidal side effects which include dystonia, akathisia, parkinsonism, muscle rigidity, etc.) Anticholinergic side effects such as:- Blurred vision
- Constipation
- Dry mouth
- Nasal congestionIncreased appetite
Weight gain
Nausea
Dizziness
Headache
VomitingUnknown frequency adverse effects include
Diarrhoea
Alopecia — hair loss
Photophobia
Pigmentation
Eczema up to exfoliative dermatitis
Urticaria
Erythema
Itching
Photosensitivity (increased sensitivity of affected skin to sunlight)
Hypersalivation — excessive salivation. Hyperprolactinaemia — elevated blood prolactin levels. This may present with the following symptoms:- Galactorrhea — the release of milk that is not associated with pregnancy or breastfeeding
- Gynaecomastia — the development of breast tissue in males
- Disturbances in menstrual cycle
- Sexual dysfunctionPigmentation of the cornea and lens
Hyperglycaemia — elevated blood glucose (sugar) levels. Hypoglycaemia — low blood glucose (sugar) levels. Disturbed concentration
Excitement
Anxiety
Insomnia
Restlessness
Nightmares
Weakness
Fatigue
Diaphoresis — excessive/abnormal sweating.Uncommon/Rare adverse effects include
Tardive dyskinesia, an often irreversible adverse effect that usually results from chronic use antipsychotic medications, especially the high-potency first-generation antipsychotics. It is characterised by slow (hence tardive), involuntary, repetitive, purposeless muscle movements. Neuroleptic malignant syndrome, a potentially fatal complication of antipsychotic drug use. It is characterised by the following symptoms:- Muscle rigidity
- Tremors
- Mental status change (e.g. hallucinations, agitation, stupor, confusion, etc.)