Details About Generic Salt ::  Chlordi1

Main Medicine Class:: Psychotherapeutic combination   

(klor-DIE-aze-ee-POX-ide/am-ee-TRIP-tih-leen)
Limbitrol DS 10–25
Class: Psychotherapeutic combination

 

Drugs Class ::

 Action Amitriptyline blocks reuptake of serotonin and norepinephrine in CNS. Chlordiazepoxide potentiates effects of GABA in CNS.

Indications for Drugs ::

 Indications Treatment of moderate to severe depression associated with moderate to severe anxiety.

Drug Dose ::

 Route/Dosage

PO 1 tablet (10 mg chlordiazepoxide with 25 mg amitriptyline) tid or qid. May increase to 6 tablets daily if needed; some patients may respond to 1 tablet bid.

Contraindication ::

 Contraindications Hypersensitivity to chlordiazepoxide or other benzodiazepines; hypersensitivity to amitriptyline or other tricyclic antidepressants; concomitant MAO inhibitor use; acute recovery phase of MI.

Drug Precautions ::

 Precautions

Pregnancy: Pregnancy category undetermined. Lactation: Excreted in breast milk. Children: Not recommended in children < 12 yr. Elderly or debilitated patients: Unit dosage to smallest effective amount to decrease risk of ataxia, oversedation, confusion or anticholinergic effects. Special risk patients: Use with caution in patients with history of seizures, urinary retention, urethral spasm, angle-closure glaucoma or increased intraocular pressure, cardiovascular disorders and hepatic or renal impairment; hyperthyroid patients or those receiving thyroid medication; schizophrenic or paranoid patients.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Hypotension; hypertension; tachycardia; palpitations; MI; arrhythmias; heart block; ECG changes; stroke. CNS: Hallucinations; hypomania; delusions; poor concentration; incoordination; tingling and paresthesias of extremities; extrapyramidal symptoms; syncope; changes in EEG patterns; dizziness; sedation; drowsiness; headache; lethargy; fatigue. DERM: Rash; urticaria; photosensitivity; edema of face and tongue; pruritus. EENT: Pupil dilation; blurred vision; nasal stuffiness; alteration in taste perception; parotid swelling. GI: Nausea; epigastric distress; vomiting; anorexia; diarrhea; black tongue; bloating; dry mouth; constipation. GU: Testicular swelling; decreased urinary frequency; menstrual irregularities; loss of bladder function; change in sex drive. HEMA: Bone marrow depression including agranulocytosis; eosinophilia; purpura; thrombocytopenia. HEPA: Jaundice; hepatic dysfunction; increased AST, ALT, alkaline phosphatase. META: Elevation or depression of glucose levels. RESP: Difficult breathing. OTHER: Weight gain or loss; paradoxical sweating; gynecomastia; breast enlargement and galactorrhea (women); syndrome of inappropriate antidiuretic hormone secretion.

Drug Mode of Action ::  

 Action Amitriptyline blocks reuptake of serotonin and norepinephrine in CNS. Chlordiazepoxide potentiates effects of GABA in CNS.

Drug Interactions ::

 Interactions

Cimetidine, fluoxetine, haloperidol, phenothiazine antipsychotic compounds, oral contraceptives: May cause increased amitriptyline blood levels. Cimetidine, oral contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: May increase chlordiazepoxide effects. Clonidine: May result in hypertensive crisis. CNS depressants, alcohol: Depressant effects may be additive. Digoxin: May increase digoxin serum levels. Guanethidine: May diminish antihypertensive effects. MAO inhibitors: May result in hypertensive crises, convulsions and death. Oral anticoagulants: May result in increased anticoagulant effect.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies, especially to drug, amitriptyline or other benzodiazepines.
  • Evaluate medical history for potential risk of drug or alcohol abuse or suicide.
  • If elective surgery is planned, drug should be discontinued several days before surgical procedure.
  • If patient is addiction prone or suicidal, remain with patient while patient takes tablet. Observe for signs of hoarding.
  • Closely monitor patients with history of hyperthyroidism or patients taking thyroid medication.
  • Monitor BP and pulse during initial therapy.
  • If patient is undergoing long-term treatment, perform periodic blood counts and liver function studies.
OVERDOSAGE: SIGNS & SYMPTOMS
  Drowsiness, temporary confusion, visual hallucinations, hypothermia, tachycardia, arrhythmias, CHF, dilated pupils, convulsions, hypotension, stupor, coma, agitation, hyperactive reflexes, muscle rigidity, vomiting, hyperpyrexia

Drug Storage/Management ::

 Administration/Storage

  • If patient has been taking MAO inhibitor, wait 2 wk before beginning limbitrol therapy. Cautiously begin treatment with reduced dosage.
  • Therapy may begin with 1 tablet at bedtime with dosage titrated upward as tolerance to CNS depressant effect develops.
  • Administer with food or water to reduce gastric irritation.
  • Give larger portion of total daily dose at bedtime.
  • Store in moisture-resistant container at room temperature.

Drug Notes ::

 Patient/Family Education

  • Instruct patient to avoid intake of alcoholic beverages and other CNS depressants because additive effects can cause dangerous level of sedation and CNS depression.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Instruct patient not to discontinue medication abruptly or change dosage without consulting with physician because withdrawal symptoms can occur.
  • Caution patient to avoid excessive exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Advise patient that dry mouth may occur and that it may be relieved by taking sips of water frequently or sucking on hard sugarless candy or gum.
  • Caution patient not to take any otc medications without consulting physician.

Disclaimer ::

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