Chlordiazepoxide hydrochloride (metaminodiazepoxide hydrochloride)
Brand Name: Apo-Chlordiazepoxide (CAN), Librium, Libritabs, Mitran, Reposans-10
Pregnancy Category D, C-IV controlled substance
Drug classes: Benzodiazepine, Antianxiety agent
Exact mechanisms of action not understood; acts mainly at subcortical levels of the CNS; main sites of action may be the limbic system and reticular formation; potentiates the effects of gamma-aminobutyric acid (GABA).
· Management of anxiety disorders or for short-term relief of symptoms of anxiety
· Acute alcohol withdrawal; may be useful in symptomatic relief of acute agitation, tremor, delirium tremens, hallucinosis
· Preoperative relief of anxiety and tension
· Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, pregnancy (increased risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (“floppy infant” syndrome reported), lactation (infants may become lethargic and lose weight).
Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment (especially in psychiatric patients, aggressive children, and those with high dosage), visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion, Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema, Drug dependence with withdrawal syndrome when drug is discontinued (more common with abrupt discontinuation of higher dosage used for longer than 4 mo),: Urticaria, pruritus, skin rash, dermatitis, Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic dysfunction, jaundice, Incontinence, urinary retention, changes in libido, menstrual irregularities, Decreased hematocrit, blood dyscrasias, Phlebitis and thrombosis at IV injection sites, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia, pain, burning, and redness after IM injection
· Increased CNS depression with alcohol, omeprazole
· Increased pharmacologic effects with cimetidine, disulfiram, oral contraceptives
· Decreased sedative effects with theophylline, aminophylline, dyphylline, oxitriphylline
· Do not administer intra-arterially; arteriospasm, gangrene may result.
· Reconstitute solutions for IM injection only with special diluent provided; do not use diluent if it is opalescent or hazy; prepare injection immediately before use, and discard any unused solution.
· Do not use drug solutions made with physiologic saline or sterile water for injection for IM injections because of pain.
· Give IM injection slowly into upper outer quadrant of the gluteus muscle; monitor injection sites.
· Do not use small veins (dorsum of hand or wrist) for IV injection.
· Monitor P, BP, R carefully during IV administration.
· Keep patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit ambulatory patients to drive following an injection.
· Reduce dosage of narcotic analgesics in patients receiving IV benzodiazepines; doses should be reduced by at least one-third or totally eliminated.
· Monitor liver and kidney function, CBC at intervals during long-term therapy.
· Taper dosage gradually after long-term therapy, especially in epileptic patients.