chlordiazepoxide

Absorption: Well absorbed from the GI tract.

Distribution: Widely distributed. Crosses the blood-brain barrier.

Metabolism/Excretion: Highly metabolized by the liver. Some products of metabolism are active as CNS depressants.

Half-Life: 5–30 hr.

Time/Action Profile ⬆ ⬇

(sedation)

ROUTE	ONSET	PEAK	DURATION
PO	1–2 hr	0.5–4 hr	up to 24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Some products contain tartrazine and should be avoided in patients with known intolerance;
Cross-sensitivity with other benzodiazepines may occur;
Comatose patients or those with pre-existing CNS depression;
Uncontrolled severe pain;
Pulmonary disease;
Angle-closure glaucoma;
Porphyria;
Lactation: Lactation.

Use Cautiously in:

Hepatic impairment;
Severe renal impairment;
History of suicide attempt or substance abuse;
OB: Use late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in neonates.
Pedi: Children 6 yr (safety and effectiveness not established);
Geri: Appears on Beers list. risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents. If possible, avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash

EENT: blurred vision

GI: constipation, diarrhea, nausea, vomiting

Metab: weight gain

Neuro: dizziness, drowsiness, depression, hangover, headache, paradoxical excitation, sedation

Misc: physical dependence, psychological dependence, tolerance

Interactions ⬆ ⬇

Drug-drug:

Use with opioids or other CNS depressants, including otherbenzodiazepines, non-benzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
Cimetidine, oral contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, propranolol, or valproic acid may enhance effects.
May ↓ efficacy of levodopa.
Effectiveness may be ↓ by rifampin or barbiturates .
Sedative effects may be ↓ by theophylline.

Drug-Natural Products:

Concomitant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression.

Route/Dosage ⬆ ⬇

Alcohol Withdrawal

PO (Adults ): 50–100 mg, repeated until agitation is controlled (up to 400 mg/day).

Anxiety

PO (Adults ): 5–25 mg 3–4 times daily.
PO Geriatric Patients ): 5 mg 2–4 times daily initially, ↑ as needed.
PO (Children >6 yr): 5 mg 2–4 times daily, up to 10 mg 2–3 times daily.

Availability ⬆ ⬇

(Generic available)

Capsules: 5 mg; 10 mg; 25 mg
In combination with: amitriptyline (generic only); clidinium (Librax). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess for anxiety and level of sedation (ataxia, dizziness, slurred speech) periodically during therapy.
- Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically during therapy.
- Assess risk for addiction, abuse, or misuse prior to administration and periodically during therapy.
- Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict the amount of drug available to patient.
- Assess risk of falls and institute fall prevention strategies.
Alcohol Withdrawal: Assess for tremors, agitation, delirium, and hallucinations. Protect patient from injury. Institute seizure precautions.

Lab Test Considerations:

Patients on prolonged therapy should have CBC and liver function tests evaluated periodically. May cause ↑ in serum bilirubin, AST, and ALT.
- May alter results of urine 17-ketosteroids and 17-ketogenic steroids. May cause ↓ response on metyrapone tests and decreased thyroidal uptake of ¹²³I and ¹³¹I.

Toxicity and Overdose:

Flumazenil reverses sedation caused by chlordiazepoxide toxicity or overdose. (Flumazenil may induce seizures in patients with a history of seizure disorder or who are on tricyclic antidepressants.)

Implementation ⬆ ⬇

Do not confuse chlordiazepoxide with chlorpromazine.
PO: Administer after meals or with milk to minimize GI irritation. Tablets may be crushed and taken with food or fluids if patient has difficulty swallowing. Administer greater dose at bedtime to avoid daytime sedation. Do not discontinue abruptly; taper by 10 mg every 3 days to reduce chance of withdrawal symptoms (depressed mood, trouble sleeping). Some patients may require longer taper period (months). Monitor patients closely with seizure disorder as abrupt withdrawal may precipitate seizures.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take chlordiazepoxide as directed. If medication is less effective after a few weeks, check with health care professional; do not increase dose. Medication should be tapered at the completion of long-term therapy. Sudden cessation of medication may lead to withdrawal (insomnia, irritability, nervousness, tremors).
Advise patient not to share medication with others; may be dangerous.
Advise patient that chlordiazepoxide is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.
May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to avoid the use of alcohol or other CNS depressants, including opioids, concurrently with chlordiazepoxide, may cause respiratory depression and overdose.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional prior to taking any Rx, OTC, vitamins, or herbal products.
Rep: May cause fetal harm. Advise patient to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding. Monitor neonates exposed to benzodiazepines during pregnancy and labor for signs of sedation, respiratory depression, withdrawal (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, feeding difficulties). Monitor neonates and infants exposed to chlordiazepoxide during breastfeeding for sedation and withdrawal symptoms. Inform women who take chlordiazepoxide during pregnancy about the National Pregnancy Registry for Other Psychiatric Medications to monitor pregnancy outcomes in women exposed to chlordiazepoxide during pregnancy. Enroll patient by calling 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/othermedications/.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇