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Chlordiazepoxide A to Z Drug Facts Chlordiazepoxide Action Indications Contraindications Route/Dosage Interactions Lab Test Interferences Adverse Reactions Precautions Patient Care Considerations Administration/Storage Assessment/Interventions Patient/Family Education (klor-DIE-aze-ee-POX-ide) Libritabs, Librium, Mitran, Reposans-10, Solium Class: Antianxiety/benzodiazepine Action Potentiates action of GABA to produce CNS depression. Indications Management of anxiety disorders; relief of acute alcohol withdrawal symptoms; relief of preoperative apprehension and anxiety. Unlabeled use(s): Treatment of irritable bowel syndrome. Contraindications Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcohol intoxication. Route/Dosage Individualize dosage. Acute symptoms may be rapidly controlled IM or IV, with subsequent oral treatment (maximum 300 mg/day). Mild-to-Moderate Anxiety ADULTS: PO 5–10 mg tid or qid. Severe Anxiety ADULTS: PO 20–25 mg tid or qid. Initial dose: IM/IV 50–100 mg, then 25–50 mg tid or qid. ELDERLY OR DEBILITATED PATIENTS: PO 5 mg bid to qid. IM/IV 25–50 mg. Preoperative Apprehension/Anxiety ADULTS: PO 5–10 mg tid or qid on days preceding surgery. IM 50–100 mg 1 hr prior to surgery. Acute Alcohol Withdrawal ADULTS: IM/IV 50–100 mg; repeat q 2–4 hr prn. PO 50–100 mg, repeat prn (maximum oral or parenteral dose is 300 mg/day). CHILDREN (> 6 YR): PO 5–10 mg bid-qid; may be increased to 10 mg bid-tid. CHILDREN (> 12 YR): IM 0.5 mg/kg/day 6–8 hr. Interactions Alcohol and CNS depressants: Additive CNS depressant effects are possible. Cigarette smoking, theophyllines: May antagonize sedative effects. Cimetidine, oral contraceptives, disulfiram, omeprazole: May increase effects of chlordiazepoxide with excessive sedation and impaired psychomotor function. Digoxin: May increase serum digoxin concentrations. Lab Test Interferences None well documented. Adverse Reactions CV: Cardiovascular collapse; hypotension; hypertension; tachycardia; bradycardia; edema; phlebitis or thrombosis at IV sites. CNS: Drowsiness; confusion; ataxia; dizziness; fatigue; apathy; memory impairment; disorientation; anterograde amnesia; restlessness; headache; slurred speech; loss of voice; stupor; coma; euphoria; irritability; vivid dreams; psychomotor retardation; paradoxical reactions (eg, anger, hostility, mania, insomnia, muscle spasms). DERM: Rash. EENT: Visual or auditory disturbances; depressed hearing. GI: Constipation; diarrhea; dry mouth; coated tongue; nausea; anorexia; vomiting. HEMA: Blood dyscrasias including agranulocytosis; anemia; thrombocytopenia; leukopenia; neutropenia. HEPA: Abnormal liver function tests; hepatic dysfunction including hepatitis and jaundice. OTHER: Dependency/withdrawal syndrome. Precautions Pregnancy: Category D. Avoid especially in first trimester due to possible increased risk of congenital malformations. Lactation: Excreted in breast milk. Children: Initial dose should be small and gradually increased. Oral form not recommended in children < 6 yr; parenteral form not recommended in children < 12 yr. Elderly or debilitated patients: Initial dose should be small and gradually increased. Use with caution in patients with limited pulmonary reserve. Dependency: Prolonged use can lead to dependency. Withdrawal syndrome has occurred within 4–6 wk of treatment, especially if drug is abruptly discontinued. For discontinuation after long-term treatment, use caution and taper dosage. Psychiatric disorders: Not intended for patients with primary depressive disorder, psychosis or disorders in which anxiety is not prominent. Parenteral administration: Reserved primarily for acute states. Renal or hepatic impairment: Observe caution to avoid accumulation of drug. Suicide: Use with caution in patients with suicidal tendencies; do not allow patient access to large quantities of drug. PATIENT CARE CONSIDERATIONS Administration/Storage Give oral form with food or milk to decrease GI irritation. Do not open capsules. Use parenteral solutions immediately after reconstitution. Discard unused portion. For intramuscular administration, reconstitute with diluent provided. Do not use diluent if opalescent or hazy. Agitate gently until dissolved. Give injection slowly deep in upper quadrant of gluteus maximus muscle. For intravenous administration, reconstitute with 5 ml sterile physiologic saline or Sterile Water for Injection. Do not use diluent for intramuscular form. Administer injection slowly over 1 min. Do not inject intra-arterially; intra-arterial injection may produce anteriospasm that can lead to gangrene. Keep powder form away from light. Store in refrigerator until reconstitution. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Consider cross-sensitivity with other benzodiazepines. Monitor BP, pulse rate and respiratory rate frequently when giving drug parenterally. Assist with ambulation and use side-rails; drowsiness and orthostatic hypotension may occur early in therapy. Monitor CBC; blood dyscrasias occur rarely with long-term use. Monitor liver function during long-term therapy. Assess for ataxia and oversedation in elderly, debilitated patient. Monitor mental status: mood, sensorium, affect, sleep pattern, drowsiness, dizziness. Notify physician of mental status changes. Observe patient closely for 3 hr following parenteral administration; bed rest is preferred. Do not permit patient to drive or perform other potentially hazardous tasks. With treatment for alcohol withdrawal, assess for tremors, agitation, delirium and hallucinations. Monitor for paradoxical reactions: excitement, stimulation, acute rage. Restrict amount of medication available to patients with suicidal tendencies. Observe for physical dependency/withdrawal symptoms with long-term use: headache, muscle pain, weakness, nausea, vomiting, increased anxiety. Because of risk of apnea and cardiac arrest with parenteral administration, have resuscitative facilities available. OVERDOSAGE: SIGNS & SYMPTOMS Drowsiness, confusion, somnolence, impaired coordination, diminished reflexes, lethargy, ataxia, hypotonia, hypotension, hypnosis, coma, death Patient/Family Education Instruct patient to take drug with food or milk to prevent GI irritation. Inform patient that drowsiness may be worse at beginning of therapy. Advise patient to use caution while driving or performing other tasks requiring mental alertness. Instruct patient to rise slowly, especially if elderly, to avoid fainting. Advise patient to report behavior changes, such as episodes of excitement, stimulation or acute rage, to physician. Inform patient receiving long-term therapy or taking high doses that withdrawal symptoms may occur if drug is suddenly discontinued. Advise patient to avoid intake of alcoholic beverages. Caution patient not to take otc medications without consulting physician. Books@Ovid Copyright © 2003 Facts and Comparisons David S. Tatro A to Z Drug Facts