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

Pregnancy category: D Lactation: Enters breast milk/not recommended

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.