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CHLORDIAZEPOXIDE is a brand name for Chlordiazepoxide. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: For short-term (2-4 weeks only) use: • symptomatic relief of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness. • Muscle spasm of varied aetiology • Symptomatic relief of…
Verbatim from this product's MHRA label. Tap a section to expand.
4). Treatment should be given for the shortest possible duration. 4). When treatment is started it may be useful to inform the patient that treatment will be of limited duration and to explain precisely how the dosage will be progressively decreased.
Moreover, it is important that the patient should be aware of the possibility of rebound phenomena, thereby minimising anxiety over such symptoms should they occur while the medicinal product has been discontinued.
Anxiety Adults:
The starting dose should be 5 mg daily increasing to a usual dose of up to 30 mg in divided doses, but up to a maximum dose of 100 mg daily, in divided doses adjusted on an individual basis. Treatment should always be as short as possible and should not continue at full dose for more than 2 weeks with a 2 week tapering off process.
Insomnia associated with anxiety Adults: 10-30 mg at bedtime. Treatment should be as short as possible and normally varies from a few days to two weeks with a maximum of four weeks, including tapering off process. Symptomatic relief of acute alcohol withdrawal 25-100 mg dose, repeated if necessary in 2-4 hours.
Muscle spasm of varied aetiology 10-30 mg daily in divided doses. Special populations Elderly and/or debilitated patients; Dosage should not exceed half the adult dose. Children; Chlordiazepoxide is not for paediatric use. 3) Patients who have taken benzodiazepines for a prolonged time may require a longer period of dosage reduction and specialist help may be appropriate.
Common adverse effects include; Drowsiness and lightheadedness during the day, sedation, unsteadiness, ataxia, these are dose-related and may persist into the following day even after a single dose. 2). Other adverse effects include; confusion, tremor, dysarthria, salivation changes and incontinence.
Rare adverse effects include; numbed emotions, reduced alertness, fatigue, headache, dizziness, muscle weakness, vertigo, or blurred vision, hypotension, gastrointestinal upsets, skin rashes, visual disturbances, changes in libido and urinary retention.
Isolated cases of blood dyscrasias and jaundice have also been reported. Amnesia Anterograde amnesia may occur using therapeutic dosages, the risk increasing at higher dosages. Amnesic affects may be associated with inappropriate behaviour.
(See warnings and precautions). Depression Pre-existing depression may be unmasked during benzodiazepine use. Psychiatric and paradoxical reactions Reactions like restlessness, agitation, irritability, aggressiveness, delusion, rages, nightmares, hallucinations, psychoses, inappropriate behaviour and other adverse behavioural effects are known to occur when using benzodiazepines or benzodiazepine-like agents.
They may be quite severe with this product. They are more likely to occur in children and the elderly. 4) Use (even therapeutic doses) may lead to the development of physical dependence: discontinuation of the therapy may result in withdrawal or rebound phenomena (see Warnings and precautions).
Psychic dependence may occur. 4). 4 Special warnings and precautions). Symptoms reported following discontinuation of benzodiazepines include headaches, muscle pain, anxiety, tension, depression, insomnia, restlessness, confusion, irritability, sweating, and the occurrence of “rebound” phenomena whereby the symptoms that led to treatment with benzodiazepines recur in an enhanced form.
Tolerance Some loss of efficacy to the hypnotic effects of chlordiazepoxide may develop after repeated use for a few weeks. Drug dependence, tolerance and potential for abuse Use of benzodiazepines may lead to the development of physical and psychological dependence upon these products.
The risk of dependence increases with dose and duration of treatment; it is also greater in patients with a history of alcohol or drug abuse, or in patients with marked personality disorders. Therefore, regular monitoring in such patients is essential, regular repeat prescriptions should be avoided and treatment should be withdrawn gradually.
Drug addiction comprises behavioural, cognitive and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use and possible tolerance or physical dependence. Physical dependence is a state that develops as a result of physiological adaptation in response to repeated drug use, which manifests as withdrawal signs and symptoms after abrupt discontinuation or a significant dose reduction of a drug.
Addiction and dependence are related but distinct presentations and in discussing these themes, terminology that apportion blame to the individual should be avoided. For all patients, prolonged use of this product may lead to drug dependence and addiction but can occur with short-term use at recommended therapeutic doses.
, major depression). Additional support and monitoring may be necessary when prescribing for patients at risk of drug misuse. A comprehensive patient history should be taken to document concomitant medications, including over-the-counter medicines and medicines obtained on- line, and past and present medical and psychiatric conditions.
Patients may find that treatment is less effective with chronic use and express a need to increase the dose to obtain the same level of symptom control as initially experienced. Patients may also supplement their treatment with additional medications to achieve the same effect.
6) Chlordiazepoxide should not be used alone in depression or anxiety with depression (may precipitate suicide)
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Chlordiazepoxide in United Kingdom.
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These symptoms may be difficult to distinguish from the original symptoms for which the drug was prescribed. In severe cases the following symptoms may occur: derealisation; depersonalisation; hyperacusis; tinnitus; numbness and tingling of the extremities; hypersensitivity to light, noise, and physical contact; involuntary movements; hyperreflexia, tremor, nausea, vomiting; diarrhoea, abdominal cramps, loss of appetite, agitation, palpitations, tachycardia, panic attacks, vertigo, short-term memory loss, hallucinations/delirium; catatonia; hyperthermia, convulsions.
Convulsions may be more common in patients with pre-existing seizure disorders or who are taking other drugs that lower the convulsive threshold such as antidepressants. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.
It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
These could be signs that the patient is developing tolerance. The risks of developing tolerance should be explained to the patient. Overuse or misuse may result in overdose and/or death. It is important that patients only use medicines that are prescribed for them at the dose they have been prescribed and do not give this medicine to anyone else.
Patients should be closely monitored for signs of misuse, abuse, or addiction. The clinical need for treatment with Chlordiazepoxide should be reviewed regularly, with frequent assessments of patients being undertaken during the course of their treatment.
Drug withdrawal syndrome Prior to starting treatment with Chlordiazepoxide, a discussion should be held with patients to explain the risk of dependence, addiction, and drug withdrawal syndrome. A withdrawal strategy for ending treatment with Chlordiazepoxide should also be put in place with the patient before starting treatment (there may be exceptions to this in specific clinical situations such as symptom management in end of life palliative care).
Drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to minimise symptoms of withdrawal. Tapering from a high dose may take in excess of weeks or months.
Patients should be informed of this when the medication is first prescribed. The reduction schedule for a patient should be tailored to the individual and should be modified to allow intolerable withdrawal symptoms to improve before making the next reduction.
If using a published withdrawal schedule, apply it flexibly to accommodate the person’s preferences, changes to their circumstances and the response to dose reductions. Suggest a slow stepwise rate of reduction proportionate to the existing dose, so that decrements become smaller as the dose is lowered, unless clinical risk is such that rapid withdrawal is needed.
If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. If women take this drug during pregnancy, there is a risk that their newborn infants will experience neonatal withdrawal syndrome.
2). If physical dependence has developed, abrupt termination of treatment will be accompanied by withdrawal symptoms. These may consist of headaches, muscle pain, extreme anxiety, depression, nervousness, tension, restlessness, confusion, irritability, sleep disturbance, mood changes, sweating and diarrhoea.
In severe cases the following symptoms may occur: derealisation (a feeling of unreality or of being separated from the body), confusional states, depersonalisation, hyperacusis, numbness and tingling of the extremities, hypersensitivity to light, noise and physical contact, psychotic manifestations including hallucinations or epileptic seizures.
Withdrawal symptoms will be worse in patients who have been dependant on alcohol or other narcotic drugs in the past, but can occur following abrupt cessation of treatment in patients receiving normal therapeutic doses for a short period of time.
Rebound symptoms A transient syndrome whereby the symptoms that led to treatment with a benzodiazepine recur in an enhanced form may occur on withdrawal of treatment. It may be accompanied by other reactions including mood changes, anxiety or sleep disturbances (insomnia) and restlessness.
2). Duration of treatment The duration of treatment should be as short as possible (see Posology) depending on the […]