Chlordiazepoxide

Indications

Chlordiazepoxide is used for: Anxiety, Insomnia, Muscle spasms, Acute symptoms of alcohol withdrawal

Adult Dose

Oral Insomnia Adult: 10-30 mg before bedtime. Muscle spasms Adult: 10-30 mg daily in divided doses. Anxiety Adult: 30 mg daily in divided doses, up to 100 mg daily in severe conditions. Acute symptoms of alcohol withdrawal Adult: 25-100 mg daily repeated as necessary. Max dose: 300 mg daily. Elderly: and debilitated patients: Dose reduction may be needed.

Child Dose

Anxiety <6 years: Safety and efficacy not established >6 years: 0.5 mg/kg/day divided PO q6-8hr, OR 5 mg PO q6-12hr; may increase dose to 10 mg PO q8-12hr

Renal Dose

Renal impairment CrCl <10 mL/min: 50% of recommended dose CrCl >10 mL/min: Dose adjustment not necessary (monitor)

Administration

May be taken with or without food.

Contra Indications

Acute pulmonary insufficiency, resp depression, patients with marked neuromuscular resp weakness; hypersensitivity to benzodiazepines; chronic psychosis; porphyria; pregnancy and lactation.

Precautions

Alcohol; sedation, dependence. Elderly and debilitated patients. Liver or kidney dysfunction. Avoid prolonged usage. Lactation: Enters breast milk/not recommended

Pregnancy-Lactation

Interactions

Cimetidine increases serum conc of chlordiazepoxide. Potentiates action of major neuroleptics. Potentially Fatal: Alcohol potentiates CNS-depressant effect of chlordiazepoxide.

Adverse Effects

Side effects of Chlordiazepoxide : >10% Ataxia,Drowsiness,Memory impairment,Sedation,Muscle weakness,Rash,Decreased libido,Menstrual disorders,Xerostomia,Salivation decreased,Increased/decreased appetite,Weight gain/loss,Micturition difficulties 1-10% Confusion,Dizziness,Disinhibition,Akathisia,Dermatitis,Hypotension,Salivation increased,Sexual dysfunction,Incontinence,Rigidity,Tremor,Muscle cramps,Tinnitus,Nasal congestion

Mechanism of Action

Chlordiazepoxide enhances activity of the inhibitory transmitter GABA in different parts of CNS by increasing neuronal-membrane permeability to chloride ions resulting to hyperpolarisation and stabilisation. It has some muscle relaxant and anticonvulsant activity.