Anti-anxiety: chlordiazepoxide, Librium
Generic Name: chlordiazepoxide
Brand Name(s): Librium
Common Use: Anti-anxiety agent
Anxiolytic
Chlordiazepoxide possesses sedative, hypnotic, anxiolytic and
muscle relaxant properties. These effects appear to be mediated through facilitation
of the actions of gamma aminobutyric acid (GABA) in the CNS.
Symptomatic relief of mild anxiety and tension and for reduction
of tension states that may accompany muscle spasm. As an adjunct in tension
states associated with insomnia, pre and postoperative apprehension, tension
headache, premenstrual tension and stress, and functional gastrointestinal,
cardiovascular, gynecological, and dermatological disorders with an emotional
overlay. May be useful in the alleviation of alcohol withdrawal syndromes,
although drug dependence may result, substituting for alcohol dependence.
May also reduce anxiety associated with psychosis, but is not a specific management
of psychosis.
Contraindications
Myasthenia gravis, known hypersensitivity to benzodiazepines.
Do not administer to patients in shock or coma. Do not add
to parenteral fluids or further dilute or mix with other drugs. Inject slowly
into a large lumen vein.
Caution patients about engaging in activities requiring mental
alertness, judgment and physical coordination, such as driving an automobile
or operating dangerous machinery. Though generally not recommended, if combination
therapy with other psychotropics seems indicated, carefully consider individual
pharmacologic effects, particularly the use of potentiating drugs such as
MAO inhibitors and phenothiazines. Patients should also be warned against
the ingestion of alcohol, since tolerance may be decreased and effects enhanced.
Periodic blood counts and liver function tests are recommended
if the medication is administered over a protracted period of time.
Physical and psychological dependence have rarely been reported
in persons taking recommended doses of chlordiazepoxide. Withdrawal symptoms
following abrupt discontinuation of chlordiazepoxide have been reported in
patients receiving treatment over extended periods of time. These symptoms
may resemble those seen with barbiturate withdrawal. The more severe withdrawal
reactions have usually been limited to those patients having taken excessive
doses over extended periods. Consequently abrupt discontinuation after long-term
use should generally be avoided and a gradual tapering of dose followed. Chlordiazepoxide
must be administered with caution to addiction-prone individuals or to those
whose history suggests possible abuse.
Adverse Side Effects
Drowsiness, ataxia and confusion may occur, especially in the
elderly and debilitated. These are reversible in most instances by proper
dosage adjustment, but are also occasionally observed at the lower dosage
ranges. In a few instances, syncope has been reported. Also encountered are
isolated instances of skin eruptions, edema, minor menstrual irregularities,
nausea and constipation, extrapyramidal symptoms, increased and decreased
libido, all infrequent and generally controlled with dosage reduction; changes
in EEG patterns (low voltage fast activity) may appear during and after treatment;
blood dyscrasias (including leukopenia and rare cases of agranulocytosis),
jaundice and hepatic dysfunction have been reported occasionally. Paradoxical
reactions, such as excitement, stimulation, elevation of mood and rage, have
been reported in psychotic patients and hyperactive aggressive children. These
reactions may be secondary to the relief of anxiety symptoms and should be
watched for particularly in the early phase of medication.
In clinical use, parenteral administration has occasionally
produced mild, transitory fluctuations in blood pressure. These reactions
have not presented a clinical problem and have not required supportive therapy.
Following injection, some patients may become drowsy or unsteady. For these
reasons, ambulatory patients should be kept under observation, preferably
in bed, after treatment.
Overdose
Drowsiness, ataxia, coma, confusion, diminished reflexes. Depression
of the cardiovascular and respiratory centers may occur. Gastric lavage; or,
in children, induce emesis and if there is no immediate response, use gastric
lavage. There have been occasional reports of excitation in patients following
chlordiazepoxide overdosage; if this occurs, barbiturates should not be used.
As with the management of intentional overdosage with any drug, it should
be borne in mind that multiple agents may have been ingested.
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