chlordiazepoxide

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, 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, nonbenzodiazepine 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:

Kava-kava, valerian, chamomile, or hops can ↑ risk of CNS depression.

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].

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.

US Brand Names ⬆ ⬇

~~Libritabs,~~ ~~Librium~~

Action ⬆ ⬇

Acts at many levels of the CNS to produce anxiolytic effect.
Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Therapeutic effects:

Sedation.
Relief of anxiety.

Classifications ⬆ ⬇

Therapeutic Classification: antianxiety agents, sedative/hypnotics

Pharmacologic Classification: benzodiazepines

Pharmacokinetics ⬆ ⬇

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.

Contr. Subst. Schedule ⬆ ⬇

Time/Action Profile ⬆ ⬇

(sedation)

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

Patient/Family Teaching ⬆ ⬇

Instruct patient to take chlordiazepoxide as directed. If medication is less effective after a few weeks, check with health care provider; do not ↑ dose.
Advise patient not to share medication with others; may be dangerous.
Caution patient not to stop taking chlordiazepoxide without consulting health care provider. Abrupt withdrawal may cause sweating, vomiting, muscle cramps, tremors, and seizures; may be life-threatening.
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 alprazolam; may cause respiratory depression and overdose. Instruct patient to consult health care provider before taking Rx, OTC, or herbal products concurrently with this medication, especially St. John's wort.
Rep: May cause fetal harm. Advise patient to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Monitor neonates exposed to benzodiazepines during pregnancy (especially during 3rd trimester) and labor for signs of sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, feeding difficulties) in the neonate. 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 alprazolam during pregnancy. Enroll patient by calling 1-866-961-2388 or visiting online at https://womensmentalhealth.org/research/pregnancyregistry/.

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Indications ⬇

Contraind./Precautions ⬆ ⬇