Amitriptyline + Chlordiazepoxide

Indications

Amitriptyline + Chlordiazepoxide is used for: Depression with Anxiety, agitation or tension.

Adult Dose

Depression with Anxiety 1 tablet (5-10 mg chlordiazepoxide/12.5-25 mg amitriptyline) PO three/four times daily; may increase to 6 tablets if necessary; 2 tablets reported to be effective in some patients. Elderly: Avoid; strong anticholinergic and sedative effects; may cause orthostatic hypotension (Beers criteria) Consider alternatives; if must use, initiate with lower initial dose; long-acting active metabolites 1 tablet (5 mg/12.5 mg) PO three times daily

Child Dose

Renal Dose

Administration

Contra Indications

Hypersensitivity. Severe cardiovascular disorders, Angle clossure glaucoma, Within 14 days of MAOIs, Any drugs or conditions that prolong QT interval, Acute recovery post-MI.

Precautions

Children and Antidepressants Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (age <24 yr) taking antidepressants for major depressive disorders and other psychiatric illnesses. Caution in BPH, urinary/GI retention, increased IOP, thyroid dysfunction, open-angle glaucoma, seizure disorders, brain tumor, respiratory impairment, respiratory disease. Risk of anticholinergic side-effects. May cause orthostatic hypotension. Paradoxical reactions including hyperactive or aggressive behavior reported. Both agents may cause sedation and impair ability to perform tasks requiring mental alertness Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; monitor during the initial 1-2 months of therapy and dosage adjustments. Not approved for treatment of dementia-related psychosis. Lactation: Excretion in milk unknown; not recommended

Pregnancy-Lactation

Pregnancy Category: D Lactation: Excretion in milk unknown; not recommended

Interactions

Adverse Effects

Side effects of Amitriptyline + Chlordiazepoxide : Drowsiness, Dry mouth, Constipation, Blurred vision, Dizziness, Bloating, Vivid dreams, Impotence, Tremor, Confusion, Nasal congestion, Edema, Syncope, Ataxia, EEG abnormalities, Menstrual irregularities, Blood dyscrasias (agranulocytosis), Hepatic dysfunction (jaundice).

Mechanism of Action

Chlordiazepoxide: Antianxiety agent; depresses all levels of CNS, including limbic and reticular formation, possibly by increasing gamma-aminobutyric acid (GABA) activity, a major inhibitory neurotransmitter. Amitriptyline: Antidepressant; neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; elicits anticholinergic effects.