Instructions for use. Interaction with other drugs

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Chlordiazepoxide is a chemical compound that belongs to the class of benzodiazepines and has pronounced anti-anxiety properties. The substance is considered the first tranquilizer in its group and has proven itself to be an effective composition. Behind last years Many more effective and less aggressive medications have appeared in pharmacology, but this anxiolytic is still actively used in medicine today. If you strictly follow the instructions for use of the drug "Chlordiazepoxide" and the doctor's instructions, potential Negative consequences therapy can be kept to a minimum. Availability of several dosage forms product allows you to expand the possibilities of its use.

You can find the trade name of the drug Elenium.

Composition and active substance

"Chlordiazepoxide" is not only a drug, but also an active substance. Pharmacies offer several products based on it, having the same or maximally similar characteristics. You can find the trade names “Chlozepid”, “Elenium”, “Librium”, “Napoton”, “Radepur”. The operation of each of them is ensured by the same component in the form of hydrochloride, which ensures its solubility in water. IN original form the chemical compound appears as a white powder, which may have a yellow tint. The composition is poorly soluble in alcohol and practically insoluble in water.

According to the principle of action, Elenium, Chlozepid and other medications are similar, but they may have features that must be taken into account during therapy.

Pharmacodynamics

Chlordiazepoxide is a benzodiazepine tranquilizer with anxiolytic properties. His healing effect is achieved by stimulating the blocking effect of GABA on the transmission of impulses between nerve cells. In parallel, selective inhibition of spinal reflexes occurs, and the excitability of the subcortical structures of the central nervous system decreases.

The effect of the drug is achieved by stimulating the blocking effect of GABA on the transmission of impulses between neurons.

Therapeutic effects of the product "Chlordiazepoxide":

• anxiolytic – relief of unreasonable fear and inexplicable anxiety, elimination of signs of emotional overstrain, weakening of stress symptoms;
• sedative – dulling of a number of manifestations of neurotic origin, in particular, obsessive anxiety, panic;
• sleeping pills – improving the quality of sleep after 3-5 days of course therapy due to a slight decrease in blood pressure and eliminating the influence of adverse factors on the body. "Chlordiazepoxide" dulls the reaction of the central nervous system to motor, autonomic and emotional stimuli, shortening the phase of falling asleep;
• anticonvulsant - due to the direct and indirect inhibitory effect on muscles and motor nerves, muscle relaxation occurs. This makes it possible to prevent the spread of epileptic activity, although without a depressing effect directly on the source of excitation;
• others - there is an antiarrhythmic effect, the ability to cause relaxation of the uterine muscles, and antihypoxic properties.

The medicine stops unreasonable fear and inexplicable anxiety.

Each of the synonyms for the drug "Chlordiazepoxide" based on the same basic component has a similar set of properties and characteristics. These products are often included as part of a combination approach to treating withdrawal symptoms due to chronic alcoholism. The drugs eliminate increased excitability, irritability and anxiety. They relieve tremors of the limbs and relieve nervous tension.

The patient experiences an improvement in mood and appetite, and pain throughout the body disappears.

Pharmacokinetics

The rate of absorption of the substance chlordiazepoxide varies depending on the dosage form, method of administration, characteristics of the body, and associated factors. After oral administration of the composition, the product is absorbed within 35-45 minutes. This indicator increases under the influence of food intake. The maximum concentration of the component is observed after 1-4 hours. Intramuscular administration liquid form The product is characterized by slow absorption of the chemical compound and the absence of changes in its content in the blood plasma. The composition passes through the placental and blood-brain barriers and penetrates into breast milk.

Intramuscular administration of the liquid form of the product is characterized by delayed absorption of the chemical compound.

"Chlordiazepoxide" is destroyed in the liver to form a number of therapeutically active metabolites. The half-life of the drug ranges from 5 to 30 hours; the rate of its breakdown products can reach 100 hours. The components are excreted by the kidneys. After stopping treatment, metabolites can be eliminated for several weeks and can be detected in blood tests.

The drug can accumulate in body tissues. This property is most clearly manifested in elderly people, against the background of reduced liver functionality.

The half-life of Chlordiazepoxide increases significantly after age 60. Severe liver damage requires dose adjustment.

Features of the drug use

Under medical supervision Chlordiazepoxide can be used to treat adults and children. It is used in neurology, narcology, anesthesiology, and psychiatry. As aid The product is prescribed by dermatologists and therapists. Taking medication as monotherapy or integrated approach Be sure to agree with your doctor.

The medicine is used in the treatment of drug addiction.

Indications for use of Chlordiazepoxide:

• psychopathy, which is accompanied by psychogenic stupor, irritability;
• neuroses and neurotic conditions;
• emotional stress and anxiety against the background of pathologies of a psychosomatic nature;
• anxiety accompanying diseases of internal organs;
• headaches, discomfort in chest, convulsive activity, sleep problems of a neurotic nature;
• tremor of various origins;
• signs autonomic dysfunction against the background of menopause, PMS;
• the need for premedication before induction general anesthesia or reassure the patient in the postoperative period;
• muscle spasms due to damage to the brain or spinal cord. Pathological muscle tension with myositis, inflammatory diseases joints;
• irritability and skin itching caused by dermatitis;
• borderline states in psychiatry, clinical picture which includes fear, panic, anxiety, intrusive thoughts;
• mild hypochondriacal or depressive disorders.

The drug is prescribed for chest discomfort.

The drug "Chlordiazepoxide" increases the effectiveness of treatment of various forms of epilepsy. It is used in the complex treatment of drug and alcohol addiction at the stage of combating the manifestations of withdrawal syndrome.

Pros and cons of the drug

The main disadvantage of the product is that it is almost impossible to find it in pharmacies under the name “Chlordiazepoxide”. Only synonyms of the product with similar characteristics are available. Today, doctors are increasingly trying to use modern medications, so the popularity of anxiolytics is falling.

TO negative points Experts and consumers attribute the increased chemical activity of the composition and a high probability of its interaction with other drugs. Violation of the rules for using the product may lead to drug addiction.

The advantage of the medicine is its proven effectiveness. On a positive note a variety of synonyms for the drug and their dosage forms is considered. If the instructions and recommendations of the doctor are strictly followed, the medication extremely rarely causes side effects.

A positive quality of the drug is its proven effectiveness.

Directions for use

The dosage form of the anxiolytic in the form of a solution is used in a hospital setting under medical supervision. Depending on the goals of therapy and the patient’s condition, the dosage can range from 50 to 100 mg active substance. Solid forms of the product are taken orally.

The daily volume of the drug is drunk in 1-4 approaches in accordance with the doctor’s prescription.

• the basic dose for an adult is 5-25 mg up to 4 times a day, for a severely weakened patient 5-10 mg up to 4 times a day;
• for sleep disorders, emotional stress, anxiety and restlessness, 10-20 mg per day is prescribed. The medicine is taken 1 time 1-2 hours before going to bed;
• as a premedication, the composition is prescribed 5-10 mg up to 4 times a day, starting therapy the day before surgery;
• for psychiatric indications, taking the Chlordiazepoxide composition begins with 50-100 mg per day, divided into 4 parts. Gradually, the daily volume can be increased to 300 mg of the active substance;
• against the background of alcohol withdrawal, the initial dosage is 50-100 mg of the active ingredient with a possible repeat of the manipulation after 2-4 hours. The daily volume of the drug should not exceed 400 mg of chlordiazepoxide. After achieving the desired effect, the dosage is gradually reduced, reaching a maintenance level;
• in pediatrics, the amount of medication depends on the age of the patient. Children under 7 years old are given up to 10 mg per day, from 8 to 14 years old - 10-20 mg per day, at 15-18 years old - 20-30 mg per day.

For alcohol withdrawal, the initial dosage is 50-100 mg of the substance.

The given figures are universal recommendations from the manufacturer, which are taken by the attending physician as the basis for therapy. Depending on the specifics of the case, these data can be modified to achieve maximum effect with minimal risks.

special instructions

All forms and variants of the drug "Chlordiazepoxide" are strictly prohibited from being combined with alcohol consumption. During the period of therapy, it is recommended to refrain from driving or working with dangerous structures. At the first signs of the development of a paradoxical reaction to the drug, the treatment course is stopped.

After achieving the desired effect from the medication, its dosage is reduced gradually, extending the exit from therapy for several days or weeks. Otherwise, the development of withdrawal syndrome is almost guaranteed. It is characterized by muscle and headaches, anxiety, confusion, hypersensitivity, and epileptic seizures.

Patients who have been taking anticoagulants for a long time before starting to take the product, antihypertensive drugs or cardiac glycosides, require special attention. During a long treatment course, regular monitoring of blood composition is indicated. The appearance of aggressiveness, suicidal tendencies, panic attacks or hallucinations in a patient is an indication to discontinue the anxiolytic.

In childhood

The medicine is not given to children under 4 years of age (in some cases 6 years of age) due to the lack of data on the effectiveness and safety of the product during this period. The use of the composition in pediatrics should be accompanied by regular assessment of the patient's condition. If there are negative changes in the child’s personality or behavior, the product should be discontinued.

In old age

Senile age is considered one of the relative contraindications to taking the drug, but dose adjustment is required in exceptional cases. Most often, standard treatment regimens are used, but increased caution is observed. During drug therapy it is necessary to take into account the increase in the half-life of the composition.

Due to a decrease in reaction speed and dulling of attention, the risk of injury may increase.

During pregnancy and lactation

The use of the drug "Chlordiazepoxide" by pregnant women is possible only in cases where there is a threat to the woman's life. The active substance of the product has a toxic effect on the fetus and creates a risk of developing birth defects when used in the first trimester. For more later taking an anxiolytic threatens to inhibit the activity of the child’s central nervous system even when maintaining therapeutic doses. Long-term therapy completed by the mother, with high degree is likely to cause drug dependence in a newborn. Taking the medicine before birth is fraught with hypothermia, weakening of the sucking reflex and hypotension in the baby.

The active substance of the drug has a toxic effect on the fetus.

For liver dysfunction

A decrease in organ functionality is an indication for dosage adjustment. In severe cases, a change in drug is required.

For impaired renal function

Problems in the functioning of organs can affect the pharmacokinetics of the drug, but individual dosage selection is required in rare cases.

Contraindications

Absolute indications for taking the drug are intolerance to the components of the drug, the age of the child under 4 years, pregnancy and lactation. The list of prohibitions also includes acute liver and kidney failure, severe muscle weakness, angle-closure glaucoma. The drug is not prescribed to persons with a history of drug or alcohol addiction, except in cases of treatment of withdrawal symptoms. Taking medication against the background of porphyria, shock, respiratory failure, or severe depression can threaten the health and life of the patient.

The medicine is not prescribed to children under 4 years of age.

Use of the drug with increased caution is possible in case of hyperkinesia, organic brain damage, bronchospasm, liver and kidney diseases. Relative contraindications to the use of the drug are psychoses, sleep apnea, elderly age, loss of control over purposeful movements.

Side effects

The drug is usually well tolerated by patients of any age.

A negative response from the body rarely develops.

The severity of symptoms can be any. The decision about the safety and relevance of further taking the drug is made by the doctor.

Possible reactions to the use of the drug "Chlordiazepoxide":

• neurological - manifestations in the form of drowsiness, dizziness, fatigue, apathy, lethargy usually occur at the beginning of the course and after some time decrease to a minimum. Headache, euphoria or depression, depression, confusion, tremors, or muscle weakness require evaluation by a physician;
• dyspeptic – excessive salivation or dry mouth, nausea with or without vomiting, loss of appetite, discomfort in the intestines, problems with the liver;
• respiratory – bronchospasm, difficulty breathing;
• immune – allergic reactions as skin itching, rashes, drug-induced lupus erythematosus;
• from the outside genitourinary system– urinary retention or incontinence, kidney problems, increased or dulled sexual desire, painful periods in women;
• from the heart and blood vessels - increased heart rate, palpitations, drop in blood pressure;
• from the blood system - changes in blood composition, increased bleeding;
• others – development of drug dependence, double vision, retrograde amnesia, weight loss.

The drug may cause rashes on the body.

An overdose of Chlordiazepoxide in an adult usually occurs after taking 500-600 mg of the active substance. It is characterized by drowsiness, lethargy or paradoxical agitation, confusion, and tremor. Examination of the victim reveals bradycardia, decreased blood pressure, shortness of breath, and dulled reflexes. In the absence of help or in severe cases, the patient falls into a coma. Help consists of gastric lavage, taking enterosorbents, symptomatic therapy. IN difficult situations The patient is given intravenous benzodiazepine antagonists, for example, Flumazenil.

Interaction with other drugs

The combination of an anxiolytic with neuroleptics, sedatives, antidepressants, anesthetics, sleeping pills or analgesics leads to depression of the central nervous system. The same effect occurs when combining medicine with alcohol.

Simultaneous use with antacids prolongs the absorption of the active substance. Combining the product with hormonal contraceptives leads to a more pronounced effect of the former, and there is a risk of breakthrough bleeding.

The anxiolytic blocks the therapeutic properties of Levodopa and potentiates the effect of muscle relaxants. Theophylline reduces the sedative effect of the drug Chlordiazepoxide. "Phenytoin" and "Phenobarbital" stimulate the destruction of the active substance of the drug. The effect of the product is enhanced by the influence of Omeprazole, Cimetidine, and Disulfiram.

The effect of the drug is enhanced by the influence of Omeprazole.

Release form, packaging, price

A product called "Chlordiazepoxide" is difficult to find in pharmacies. Instead, you can purchase the drugs “Elenium”, “Chlozepid”, “Librium” in the form of dragees or tablets at a price of 150 rubles, depending on the drug and its manufacturer.

Storage conditions and periods

Preparations based on the substance chlordiazepoxide are available in pharmacies with a prescription. The shelf life and conditions are indicated on the packaging.

Registration number:

P No. 015067/01-2003

Tradename

ELENIUM ® )

International nonproprietary name

CHLORDIAZEPOXIDE

Chemical name

4-hydroxy7-chloro-2-methylamine-5-phenyl-3H-1,4-benzodiazepine

Dosage form, dose

film-coated tablets, 10 mg

Description

Green coated tablets, broken white, round, convex on both sides, without stains, defects or cracks.

Composition of the drug

active substance:
Chlordiazepoxide 10 mg

Excipients:

Pharmacotherapeutic group:

Group affiliation according to the ATS classification: N 05 BA.

Anxiolytic agent

PHARMACOLOGICAL PROPERTIES

Pharmacodynamics

Elenium belongs to the group of benzodiazepine derivatives. The mechanism of action of the drug is associated with the inhibitory endogenous neurotransmitter gamma-aminobutyric acid (GABA) and GABA-A receptors, through which the neurotransmitter realizes its effects in the central nervous system.

Like all other benzodiazepines, Elenium enhances the inhibitory effect of GABAergic neurons in the cerebral cortex, hippocampus, cerebellum, spinal trunk and other structures of the central nervous system.

Clinically, Elenium has anxiolytic, hypnotic, sedative, central muscle relaxant and anticonvulsant effects.

Pharmacokinetics

Suction

After oral administration, Elenium is well absorbed from the digestive tract.

The maximum concentration of the drug in the blood serum (Cmax) is achieved after 2 hours and is 0.76 - 2.05 mcg/ml. The drug reaches equilibrium concentration in the blood serum (stationary phase) within 3 days.

Distribution

The drug is 96% bound to blood proteins. Penetrates through the blood-brain and placental barriers and into mother's milk.

Metabolism

Elenium undergoes biotransformation in the liver to pharmacologically active metabolites, which prolong the duration of action of the drug. The main metabolites are: desmethylchlordiazepoxide and demoxepam.

The half-life of the drug from blood serum (t 1/2) is 6 - 30 hours (the period of elimination of active metabolites is much longer and amounts to several days). In patients with renal failure, the half-life of Elenium may be prolonged.

Selection

Elenium and its metabolites are excreted in the urine; about 1 - 2% of the drug is excreted unchanged.

INDICATIONS FOR USE

• states of anxiety and fear
• states of excitation during alcohol withdrawal syndrome
• sleep disturbances accompanied by anxiety and fear.
• states of increased tension in skeletal muscles of various origins
• for premedication: preparation for long-term diagnostic procedures and operations.

Do not use Elenium in children under 4 years of age.

The drug should be used strictly as prescribed by the doctor to avoid complications.

METHOD OF APPLICATION AND DOSES

The dosage and duration of treatment should be selected individually for each patient in order to obtain maximum treatment effects.

The following doses are usually used:

Adults

states of fear and anxiety
5 - 10 mg 3 - 4 times a day, up to 30 - 40 mg/day, with severe conditions the dose of the drug can be increased to 20–25 mg 3–4 times a day (up to 100 mg/day);

states of excitation during alcohol withdrawal syndrome
at the beginning of treatment 50 – 100 mg. If necessary, the dose of the drug can be increased to a maximum of 300 mg/day. Then the dose should be gradually reduced.

sleep disorders accompanied by anxiety and fear
10 – 20 mg at bedtime

states of increased tension in skeletal muscles of various origins
10 – 30 mg/day in divided doses

preparation for long diagnostic procedures and operations
the day before surgery or a diagnostic procedure, 5–10 mg is prescribed 3–4 times a day.

Maximum daily dose: up to 100 mg/day in divided doses (states of anxiety and fear);

with alcohol withdrawal syndrome -
up to 300 mg/day in divided doses.

The drug should not be used in children under 4 years of age.
Treatment should begin with low doses.

Children aged 4-7 years – 5-10 mg/day; 8-14 years – 10-20 mg/day; 15-18 years – 20-30 mg/day; frequency of use 3-4 times/day.

Elderly patients (over 65 years old)

Patients with impaired liver and kidney function.

Prescribe the drug with caution to patients with impaired liver and kidney function. The dose of the medication may need to be reduced. The duration of treatment is usually 4 weeks (including the time of gradual reduction of the drug dose). Do not take the drug for more than 4 weeks without re-evaluating the need to continue therapy.

You cannot abruptly discontinue the drug; a gradual, doctor-controlled, dose reduction is always necessary. Abrupt withdrawal of Elenium can lead to sleep and mood disorders, and even to mental disorders. Abrupt withdrawal of long-term therapy or therapy requiring large doses of the drug is especially dangerous. Withdrawal symptoms are then more pronounced.

SIDE EFFECT

The most common undesirable effects during treatment with the drug are: drowsiness, impaired coordination of movements and balance, disorientation. They usually appear in elderly patients. An appropriate dose reduction in patients of this age group significantly reduces the incidence of side effects.

In addition, you may experience:

• dizziness
• tachycardia
• bronchorrhea, bronchospasm
• urinary retention
• skin allergic reactions
• swelling
• violation menstrual cycle among women
• disorders of the gastrointestinal tract (nausea, intestinal colic, constipation, diarrhea)
• decreased or increased libido
• fainting

Very rarely:

• from the hematopoietic system: agranulocytosis, thrombocytopenia, yellowness of the skin
• paradoxical reactions (fear, states of psychomotor agitation, insomnia).

WARNINGS

If paradoxical reactions occur, treatment should be stopped immediately.

Long-term use of chlordiazepoxide leads to a gradual weakening of the effect of the drug as a result of the development of the phenomenon of tolerance.

Long-term use of the drug contributes to the development of psychophysical drug dependence and withdrawal syndrome in the event of abrupt withdrawal of chlordiazepoxide. Withdrawal syndrome is characterized by psychomotor agitation, fear, autonomic disorders and insomnia.

During treatment with chlordiazepoxide and for 3 days after its completion, do not drink any alcoholic beverages.

CONTRAINDICATIONS

• individual intolerance to the drug
• respiratory disorders of central origin and severe conditions of respiratory failure, regardless of cause
• acute diseases kidneys and liver
• renal failure
• alcohol intoxication
• CNS depression by various substances
• myasthenia gravis
• angle-closure glaucoma
• disturbances of consciousness

Do not use in children under 4 years of age.

USE IN PREGNANCY AND BREAST-FEEDING

The use of a medicine during pregnancy is allowed only if its use in the mother has absolute indications, and the use of a safer alternative remedy impossible or contraindicated.

During treatment with Elenium, you should not breastfeed. If it is necessary to use the drug in the mother, breastfeeding must be interrupted.

INTERACTIONS WITH OTHER MEDICINES

Pharmaceutical

Pharmaceutical types of incompatibility are not defined

Pharmacodynamic

The inhibitory effect of Elenium on the central nervous system is enhanced by all drugs with a similar effect, for example. barbiturates, centrally acting blood pressure lowering drugs, antipsychotics, antidepressants, anticonvulsants, narcotic analgesics, hypnotics. Ethyl alcohol has a similar effect. Drinking alcohol during treatment with Elenium, in addition to its cumulative depressant effect on the central nervous system, can provoke paradoxical reactions: psychomotor agitation, aggressive behavior.

The drug enhances the effect of drugs that reduce skeletal muscle tone.

Pharmacokinetic

Rifampin can accelerate the metabolism of Elenium and weaken its effect.
Cimetidine can inhibit the metabolism of Elenium and enhance its effect.
Smoking may weaken the effects of Elenium.

OVERDOSE

As a result of an overdose of Elenium, the following symptoms may appear: drowsiness, disorientation, slurred speech, and in severe cases, loss of consciousness and coma.

In case of acute poisoning, it is necessary to empty the stomach (vomiting, gastric lavage).

Treatment for Elenium overdose is primarily symptomatic and consists of monitoring basic vital signs (respiration, pulse, blood pressure).

A specific antidote is flumazenil (a benzodiazepine receptor antagonist).

SPECIAL INSTRUCTIONS

Impact on the ability to drive vehicles and maintain moving mechanical devices

During treatment with the drug and for 3 days after its completion, you should not drive a vehicle, service moving mechanical devices, or perform work that requires special attention and quick response.

RELEASE FORM

Film-coated tablets 10 mg.

Package

The drug is packaged in 25 tablets per blister (PVC/aluminum). Two blisters with instructions for use are placed in an individual cardboard box

STORAGE CONDITIONS

Store at temperatures up to 25°C. Protect from light and moisture.
The drug belongs to the list of potent drugs.
Keep out of the reach of children.

BEST BEFORE DATE

4 years
Before using the drug, you must check the expiration date indicated on the packaging. The drug should not be used after the date indicated on the package.

CONDITIONS OF VACATION FROM PHARMACIES

Dispensed by prescription.

COMPANY - MANUFACTURER

Tarkhomi pharmaceutical plant "POLFA" J.O.

Contraindications Chlordiazepoxide: Hypersensitivity, severe myasthenia gravis, respiratory depression, angle-closure glaucoma, acute liver and/or kidney diseases, pregnancy (first trimester), breastfeeding, age up to 4 years.

Restrictions on use: Glaucoma, liver and/or kidney dysfunction, sleep apnea syndrome, severe cardiac and respiratory failure, ataxia (except neurotic), psychosis (possibly a paradoxical increase in symptoms), drug or alcohol dependence (except for the treatment of acute withdrawal syndrome), pregnancy (II and III trimester), old age.

Use of Chlordiazepoxide during pregnancy and breastfeeding: Contraindicated in the first trimester of pregnancy (increases the risk of congenital malformations when prescribed during this period). In II and III trimester pregnancy is possible if the expected effect of therapy exceeds the potential risk to the fetus. Breastfeeding should be stopped during treatment.

Side effects:From the nervous system and sensory organs: drowsiness, lethargy, impaired memory and concentration, slowed mental and motor reactions, muscle weakness, gait disturbance, ataxia, confusion, disorientation, dizziness, headache, EEG changes.
From the outside of cardio-vascular system and blood (hematopoiesis, hemostasis): tachycardia, palpitations, arterial hypotension (when taking high doses), thrombocytopenia, agranulocytosis.
From the gastrointestinal tract: dry mouth, nausea, constipation or diarrhea, intestinal colic, liver dysfunction, yellowness of the skin.
Allergic reactions: skin rash, itching, peeling of the skin.
Others: difficulty breathing, urinary retention, menstrual irregularities, changes in libido (increase or decrease).
Possible addiction, drug dependence, withdrawal syndrome, etc. (see “Precautions”).

Interaction: Enhances the effect of alcohol and central nervous system depressants (narcotic analgesics, anesthetics, sleeping pills, neuroleptics with a pronounced sedative effect), muscle relaxants, etc. Antacids slow down the absorption (but do not reduce the degree of absorption) of chlordiazepoxide. Chlordiazepoxide may reduce the effect of levodopa. Cimetidine, estrogen-containing oral contraceptives, disulfiram and erythromycin slow down the metabolism of chlordiazepoxide in the liver, increase its concentration in the blood and delay elimination. Smoking may decrease the effect of chlordiazepoxide.

Overdose:Symptoms: CNS depression varying degrees severity (from drowsiness to coma) - severe drowsiness, lethargy, weakness, decrease muscle tone, prolonged confusion, disorientation, slurred speech, suppressed reflexes, coma; Respiratory depression and hypotension are also possible.
Treatment: induction of vomiting, immediate gastric lavage, vital monitoring important functions, symptomatic therapy, intravenous infusion of solutions (to enhance diuresis), ensuring adequate ventilation of the lungs; in case of hypotension, administration of norepinephrine. If agitation develops, barbiturates should not be used. The benzodiazepine receptor antagonist flumazenil is used as a specific antidote (in a hospital setting). Hemodialysis is ineffective.

Directions for use and dosage: Inside. Doses (single and daily) and duration of treatment are selected strictly individually, depending on the nature and course of the disease, tolerability, etc. Treatment must begin with the lowest effective dose corresponding to the specific form of pathology.
The usual single dose for adults is 5–10 mg, the usual daily dose is 20–60 mg (in 2–4 doses). In case of tension in combination with sleep disturbance - 10–20 mg 1 time per day 1–2 hours before bedtime. In psychiatry - 50-100 mg/day, for alcohol withdrawal syndrome - up to 300 mg/day in 3-4 doses.
Elderly and old age, weakened patients, patients with liver and/or kidney diseases should be prescribed smaller doses (single dose - 2.5–5 mg). The duration of treatment should not exceed 2.5 months. Repeated course (if necessary) - no earlier than after 3 weeks.
For children starting from the age of 4 years, the dose (and duration of treatment) is selected individually, depending on age, body weight, etc.

Precautionary measures: It should be borne in mind that when anxiety and depression are combined, suicide attempts are possible.
Use with caution simultaneously with other psychotropic drugs. Should not be administered concomitantly with MAO inhibitors and phenothiazines.
At long-term use(for several months), especially in high doses, addiction and drug dependence are possible. Withdrawal of chlordiazepoxide should be done gradually by reducing the dose to reduce the risk of withdrawal syndrome characterized by tremors, cramps, abdominal or muscle spasms, vomiting, perspiration. With abrupt withdrawal, psychomotor agitation, fear, autonomic disorders, and insomnia are also possible.
Chlordiazepoxide should not be taken for more than 4 weeks without re-evaluating the patient's condition to decide whether to continue therapy.
Probability of occurrence side effects higher in older people.
With long-term use, it is necessary to periodically monitor the peripheral blood picture and liver function.
There are reports that when treating mentally ill patients and children with aggressive behavioral traits with chlordiazepoxide, paradoxical reactions were observed (psychomotor agitation, fits of rage, etc.). If paradoxical reactions develop, treatment should be stopped immediately.
Please be aware that chlordiazepoxide may reduce mental alertness in children.
It should be borne in mind that there are reports of effects on blood coagulation in patients taking concomitant oral anticoagulants and chlordiazepoxide (in clinical studies the cause and consequences of this interaction have not been established). There are isolated reports of exacerbation of porphyria under the influence of chlordiazepoxide. Hypoproteinemia may predispose to an increased incidence of sedative side effects.
During treatment and for 3 days after its discontinuation, it is necessary to avoid taking alcoholic drinks; drivers of vehicles and people whose work requires quick mental and physical reaction, and is also associated with increased concentration of attention, during this period you should not engage in professional activities.

Special instructions: Anxiety and tension associated with everyday life stress do not usually require treatment with anxiolytics.

Other drugs containing active ingredients Chlordiazepoxide

Chlordiazepoxide belongs to the group benzodiazepines . This is one of the first representatives of tranquilizer-anxiolytics. According to their own physical properties– white or white with a yellow tint powder. The medicine is practically insoluble in water and difficult to dissolve in alcohol. Molecular weight = 299.1 grams per mole.

The product is released in the form hydrochloride , this form is highly soluble in water. Chlordiazepoxide is sold in the form of tablets, capsules and dragees of various dosages; solution for injection.

pharmachologic effect

Sedative, anxiolytic, muscle relaxant, hypnotic.

Pharmacodynamics and pharmacokinetics

Chlordiazepoxide enhances sedative effect gamma-aminobutyric acid , induces post- and presynaptic inhibition of nerve impulses in the central nervous system. The substance stimulates benzodiazepine receptors of the allosteric center of postsynaptic GABA receptors in the brain stem and interneurons of the lateral horns of the spinal cord. Under the influence of the drug, the excitability of the thalamus, hypothalamus and limbic system of the brain decreases. Inhibition of polysynaptic spinal reflexes is observed.

The substance has an ansiolitic effect, as it affects the amygdala complex of the limbic system. The medicine reduces emotional stress, eliminates fear and anxiety, and a feeling of restlessness. Chlordiazepoxide drugs exhibit a pronounced sedative effect and affect the functioning of the brain stem and nonspecific nuclei in the thalamus. The hypnotic effect is caused by the ability to depress cells of the reticular formation in the trunk um.

The substance increases the body's resistance to emotional, motor and autonomic stimuli, which can disrupt the mechanism of normal falling asleep and staying asleep. During the first 3-5 days of taking the drug, a pronounced hypnotic effect develops, and a slight decrease in blood pressure occurs. Reduces feelings of panic, fear and anxiety.

The medicine has an antiepileptic effect. However, it is poorly developed, since the drug causes muscle relaxation moderate degree, inhibits polysynaptic spinal afferent inhibitory pathways , some motor nerves and muscles.

The tablet form of the drug is well absorbed after oral administration. Food can slightly slow down the absorption of medicine from the gastrointestinal tract. The product reaches its maximum concentration within half an hour - 4 hours. Equilibrium concentration can be observed with systematic use for at least 5 days (up to 12). The degree of binding to plasma proteins is up to 96%. The half-life is from 7 to 28 hours.

The drug is actively metabolized in the body, reactions occur hydroxylation , N-demethylation , deamination , as a result, the following are formed: desmethyl chlordiazepoxide , desmethyldiazepam , demoxepam And . After finishing taking the drug, its active metabolites can be detected within several days and even weeks; the substance and metabolites tend to accumulate in the body. The medicine is eliminated through the kidneys.

Chlordiazepoxide crosses the blood-brain barrier, into breast milk and the placenta. Pharmacokinetic parameters change somewhat in liver diseases, processes slow down in elderly patients.

Chlordiazepoxide rarely causes the following reactions:

• , tremor , ataxia;
• blurred vision, nausea, dry mouth and constipation, increased drooling;
• increased or decreased sexual activity, urinary incontinence, arterial hypotension , disruptions in the menstrual cycle;
• allergic reactions on the skin, peeling, itching.

Paradoxical reactions occur very rarely, anxiety , excitement of the central nervous system, hiccups, jaundice and increased activity of liver enzymes, impaired respiratory function.

With long-term treatment, the patient may develop drug dependence and memory problems.

Chlordiazepoxide, instructions for use (Method and dosage)

The medicine is prescribed internally:

• from 5 to 25 mg, 3-4 times a day;
• elderly patients – from 5 to 10 mg, 2-4 times a day;
• for anxiety and tension - 15 mg, once a day before bedtime;
• For premedication – 5-10 mg, 3-4 times a day, the day before the procedure;
• at withdrawal syndrome – 50 or 100 mg, after 4 hours – another 50 mg;
• children from 6 years old - up to 10 mg per day, up to 14 years old - 20 mg per day, from 15 years old - up to 30 mg per day.

The maximum amount of the drug per day is 0.4 grams (for alcoholic withdrawal symptoms ).

The medicine is administered intravenously under medical supervision. personnel in a hospital setting. A single dosage ranges from 50 to 100 mg.

Overdose

In case of overdose, severe depression of the central nervous system is observed, up to the state. Other symptoms: slurred speech, decreased muscle tone, confusion, respiratory depression, hypotension .

It is recommended to induce vomiting, rinse the stomach, and carry out symptomatic therapy. Solutions are administered intravenously to enhance diuresis, ensure normal breathing, administer norepinephrine . The introduction of an antidote is indicated - flumazenil . is not carried out.

Interaction

Chlordiazepoxide enhances the sedative effect of neuroleptics, sedatives, antidepressants, anesthetics, hypnotics, analgesics, ethyl alcohol, especially when used parenterally.

At simultaneous administration with antacids, the absorption time of the drug is prolonged.

Hormonal contraceptives enhance the effects of taking Chlordiazepoxide. The risk of breakthrough bleeding increases.

The medicine enhances the effect of muscle relaxants, inhibits the antiparkinsonian effect withdrawal syndrome .

If during treatment the patient develops paradoxical reactions, the medicine is discontinued.

You cannot operate a machine or perform reactions that require high concentration.

With alcohol

The substance cannot be combined with alcohol.

Drugs containing (Analogs)

Level 4 ATX code matches:

Drug analogues: Napoton , Radepur 10 , Chlozepida film-coated tablets Elenium , Amixid (in combination with ).

Formula: C16H14ClN3O, chemical name: 7-chloro-N-methyl-5-phenyl-3H-1,4-benzodiazepine-2-amino-4-oxide (as hydrochloride).
Pharmacological group: neurotropic drugs/anxiolytics.
Pharmachologic effect: anxiolytic, hypnotic, sedative, muscle relaxant, central.

Pharmacological properties

Chlordiazepoxide is a benzodiazepine derivative. Chlordiazepoxide has an effect on many structures of the central nervous system, primarily on the hypothalamus and limbic system, that is, on structures that are associated with the regulation of emotional activity. Chlordiazepoxide interacts with specific benzodiazepine receptors, which are located in the postsynaptic GABA-A receptor complex in the amygdala, cerebral cortex, striatum, hippocampus, cerebellum, hypothalamus, spinal cord. Chlordiazepoxide, like other benzodiazepines, enhances the inhibitory effect of GABAergic neurons in the cerebral cortex, hypothalamus, and thalamus. For benzodiazepines, including chlordiazepoxide, the presence of specific binding sites has been established, which are protein structures of the cell membrane and are associated with a complex that consists of a chloride channel and the GABA-A receptor. Chlordiazepoxide modulates the sensitivity of the GABAergic receptor and increases the receptor's affinity for gamma-aminobutyric acid, which is an inhibitory endogenous neurotransmitter. As a result of activation of the GABA-A or benzodiazepine receptor, the transport of chlorine ions into the neuron through the chloride channel increases, which leads to hyperpolarization of the cell membrane and inhibition of neuron activity. Chlordiazepoxide blocks polysynaptic reflexes. Chlordiazepoxide clinically has a sedative, anxiolytic, moderate hypnotic effect, has an anticonvulsant effect, and reduces skeletal muscle tone. Chlordiazepoxide has a pronounced sedative effect on the central nervous system. Chlordiazepoxide suppresses agitation, anxiety, and emotional stress. Chlordiazepoxide reduces fears and obsessive thoughts, and increases susceptibility to hypnosuggestive treatment. Chlordiazepoxide relieves tremor, has an antipanic effect, and has a weak anticonvulsant effect. Chlordiazepoxide reduces the severity of fear and anxiety associated with upcoming surgery. In large doses, chlordiazepoxide can reduce psychomotor agitation. Chlordiazepoxide causes moderate muscle relaxation. Chlordiazepoxide exhibits a moderate hypnotic effect, usually expressed in the first 3 to 5 days of treatment, then the positive effect on sleep is due to the elimination of various psychogenic stimuli. Chlordiazepoxide has a mild analgesic effect and increases appetite. Relieves symptoms of acute alcohol withdrawal, such as nervous tension, anxiety, agitation, restlessness, tremors and others.
Chlordiazepoxide is highly lipophilic and is almost completely absorbed after oral administration. The time of onset of action and the rate of absorption of chlordiazepoxide may vary. With a single oral dose of 15 - 25 mg of chlordiazepoxide, absorption occurs within 35 - 45 minutes. Eating slows down absorption. The maximum concentration of chlordiazepoxide in blood plasma is achieved after 0.5 - 4 hours. Chlordiazepoxide is 96% bound to plasma proteins. The equilibrium concentration of chlordiazepoxide is achieved within 5 to 12 days from the start of therapy. Chlordiazepoxide penetrates the blood-brain and placental barrier and is excreted from breast milk. Chlordiazepoxide is slowly absorbed from muscle tissue. Chlordiazepoxide is metabolized in the liver by oxidation, N-demethylation, deamination, hydroxylation with further glucuronidation, resulting in the formation of pharmacologically active metabolites (desmethyl chlordiazepoxide, oxazepam, demoxepam, desmethyldiazepam). The half-life of chlordiazepoxide is 5 - 30 hours, its metabolites: oxazepam - 5 - 15 hours, desmethyl chlordiazepoxide - 8 - 24 hours, demoxepam - 14 - 95 hours, desmethyldiazepam - 30 - 100 hours. Chlordiazepoxide is excreted by the kidneys (1 - 2% unchanged, 3 - 6% excreted bound). Chlordiazepoxide accumulates (especially in elderly patients and in cases of impaired liver function). Chlordiazepoxide is a benzodiazepine with long period half-life, elimination after discontinuation of chlordiazepoxide therapy occurs slowly, since the metabolites remain in the blood for several days or even weeks. The accumulation of chlordiazepoxide and its active metabolites upon repeated use is significant. In elderly patients, the half-life of chlordiazepoxide is 60% longer than in younger patients, while the total clearance of chlordiazepoxide in elderly patients is not affected, as the prolongation of the half-life is counterbalanced by the increase in volume of distribution that occurs at this age. In elderly patients, the absorption and metabolism of chlordiazepoxide are slower. In liver cirrhosis, the clearance of chlordiazepoxide decreases, since the drug has pronounced hepatic metabolism, so dose adjustment is necessary. Metabolic transformations slow down significantly when the liver is damaged.
A reproduction study in animals showed that administration of chlordiazepoxide to rats at doses of 10, 20 and 80 mg/kg per day did not cause lactation disturbances in females, as well as the development of birth defects and growth disorders in newborns. In another study, administration of chlordiazepoxide at a dose of 100 mg/kg per day revealed a significant decrease in the fertilization rate, a noticeable decrease in body weight and survival of newborn rat pups.

Indications

Short-term and in emergency cases with symptomatic therapy anxiety disorders which are accompanied by sleep disorders; anxiety disorders of various origins (accompanying psychotic symptoms, psychoorganic syndromes); neurotic conditions, which are accompanied by excitement, anxiety, emotional stress, increased irritability, insomnia; increased muscle tone of various origins; acute alcohol withdrawal syndrome and patients with drug addiction; neurotic ataxia, cardialgia, tension headache, causalgia, esophagospasm, facial hemispasm, hysterical states (hysterical attack, mutism, amblyopia, paralysis), hiccups, psychogenic stupor; neurosis-like and psychopathic-like disorders in patients with organic brain damage, cerebral atherosclerosis; infectious delirium; rheumatic and neurotic hyperkinesis; premenstrual syndrome, menopause, vegetative-vascular dystonia; premedication (preparation for long operations and diagnostic procedures), postoperative period; complex treatment for schizophrenia with neurosis-like symptoms, as well as for diseases that are accompanied by irritability, itching, insomnia, including eczema.

Method of administration of chlordiazepoxide and dose

Chlordiazepoxide is taken orally, before or during meals, with a small amount of water. The dosage regimen and duration of the course of therapy are established strictly as prescribed by the doctor, depending on the condition and response of the patient. Chlordiazepoxide should not be discontinued abruptly. A gradual, physician-controlled reduction in the dose of chlordiazepoxide is necessary. Abrupt withdrawal of chlordiazepoxide may lead to the development of withdrawal syndrome.
Typically, chlordiazepoxide is taken up to 30 mg per day in divided doses every 6 to 8 hours. In special cases, higher doses of chlordiazepoxide may be used depending on individual needs. The maximum daily dose of chlordiazepoxide is 100 mg.
Anxiety conditions that are combined with insomnia: 10 - 30 mg 1 time 1 - 2 hours before bedtime.
the initial dose is 30 - 100 mg, if necessary, repeat the same dose after 2 - 4 hours, maximum dose is 200 mg per day, then the dose is reduced to a maintenance level.
Conditions of increased muscle tone: 10 mg to 30 mg per day in divided doses.
starting one day before surgery, take 10 mg 3-4 times a day.
It is recommended to start therapy with lower doses and gradually increase them. Chlordiazepoxide should not be taken continuously. The course of therapy is usually no more than 4 weeks (including the time of gradual reduction in the dose of chlordiazepoxide). In some cases, when re-evaluating the patient's condition, the doctor may continue treatment. A repeated course (if necessary) is possible no earlier than after 3 weeks.
Elderly patients more sensitive to drugs that act on the central nervous system (including chlordiazepoxide). When using chlordiazepoxide in elderly patients, it is recommended to use the lowest effective dose possible. The doses used should not exceed half the dose prescribed to adult patients.
Carefully prescribe chlordiazepoxide to patients with impaired functional state of the liver and/or kidneys. For these patients, the doctor sets the dose individually, depending on the degree of insufficiency of liver and/or kidney function.
To avoid complications, chlordiazepoxide must be used strictly as prescribed by your doctor.
States of nervous tension and fear that are associated with problems Everyday life, are not an indication for the use of chlordiazepoxide.
Long-term use of chlordiazepoxide contributes to the development of psychophysical drug dependence and withdrawal syndrome when the drug is abruptly discontinued.
Long-term use of chlordiazepoxide as a result of the development of tolerance leads to a gradual weakening of the effect of the drug.
Chlordiazepoxide should not be discontinued abruptly. A gradual reduction in the dose of chlordiazepoxide is necessary, which should be monitored by a physician.
Abrupt withdrawal of chlordiazepoxide may lead to the development of withdrawal syndrome (anxiety, headaches, muscle pain, irritability, confusion, derealization, hyperacusis, depersonalization, paresthesia in the extremities, light hypersensitivity, tactile hypersensitivity, epileptic seizures, hallucinations). At long-term treatment or treatment with high doses of chlordiazepoxide, withdrawal symptoms may be particularly pronounced. Also, withdrawal syndrome may develop during intervals between the use of individual doses of chlordiazepoxide.
Chlordiazepoxide, as well as other benzodiazepines and similar drugs, can cause antegrade amnesia.
Benzodiazepines, including chlordiazepoxide, and similar drugs should not be used as monotherapy for anxiety that is associated with depression or depression. Monotherapy data medicines increases the risk of developing suicidal thoughts.
Chlordiazepoxide should be used with great caution in patients who have symptoms of endogenous depression. These patients may experience suicidal thoughts. These patients should be prescribed chlordiazepoxide in the smallest doses possible, due to the possibility of intentional overdose.
The use of benzodiazepines, including chlordiazepoxide, and similar drugs in patients with psychosis is not recommended.
Chlordiazepoxide should be used with caution in patients with porphyria. The use of chlordiazepoxide may increase the symptoms of porphyria.
Chlordiazepoxide should be used with caution in patients with spinal and cerebellar ataxia.
Chlordiazepoxide should be used with caution in patients with open-angle glaucoma.
The use of benzodiazepines, including chlordiazepoxide, and similar drugs in patients with severe hepatic impairment is not recommended because they may precipitate the development of hepatic encephalopathy. Liver failure may lead to increased adverse reactions benzodiazepines, including chlordiazepoxide.
Chlordiazepoxide should be used with caution in elderly patients. Due to increased adverse reactions in this age group, mainly in the form of impaired coordination of movement and orientation (threat of falls, injuries), elderly patients should use lower doses of chlordiazepoxide.
Benzodiazepines, including chlordiazepoxide, and similar drugs should be used with extreme caution in patients with a history of drug and alcohol dependence (including drug addiction). These patients should be strictly monitored while using chlordiazepoxide, since these patients are at risk of developing mental dependence and addiction.
Chlordiazepoxide should be used with caution in patients with liver disease, chronic renal failure, and chronic respiratory failure. These patients may require a reduction in the dose of chlordiazepoxide.
With prolonged use of chlordiazepoxide, it is necessary to monitor the peripheral blood picture and the activity of liver enzymes.

If patients develop unusual reactions during the use of chlordiazepoxide, such as acute conditions agitation, increased aggressiveness, feelings of fear, hallucinations, thoughts of suicide, increased muscle cramps, shallow sleep, difficulty falling asleep, chlordiazepoxide therapy should be discontinued.
It must be taken into account that suicide attempts are possible when anxiety and depression are combined.

Chlordiazepoxide should not be taken for more than 4 weeks without re-evaluating the patient to decide whether to continue treatment.
Elderly patients are at higher risk of developing adverse reactions.

Hypoproteinemia may predispose to an increased incidence of sedative side effects.
Do not drink any alcoholic beverages while using chlordiazepoxide and for three days after its completion.
Dosage forms of chlordiazepoxide containing lactose should not be used in patients with rare hereditary disorders associated with lactase deficiency, galactose intolerance, and poor absorption of glucose-galactose.
Dosage forms of chlordiazepoxide containing sucrose should not be used in patients with rare hereditary disorders associated with glucose-galactose malabsorption syndrome, fructose intolerance, and sucrase-isomaltase deficiency.
During treatment with chlordiazepoxide and for three days after its completion, you should not engage in potential activities. dangerous species activities that require increased concentration attention and speed of psychomotor reactions (including control vehicles, mechanisms).

Contraindications for use

Hypersensitivity, depression of the respiratory center, acute respiratory failure, acute alcohol intoxication, weakening of vital functions, acute intoxication with drugs that have a depressing effect on the central nervous system (hypnotics, narcotics, psychotropic drugs), shock, myasthenia gravis, coma, severe chronic obstructive diseases lungs (progression of the degree of respiratory failure), angle-closure glaucoma ( acute attack or predisposition), phobias, obsessive states, chronic psychosis, acute liver and/or kidney diseases, bipolar affective disorder(suicidal tendencies may be noted), age under 18 years, pregnancy, lactation; for dosage forms of chlordiazepoxide that contain lactose: rare hereditary disorders that are associated with lactase deficiency, galactose intolerance, poor absorption of glucose-galactose; for dosage forms of chlordiazepoxide that contain sucrose: rare hereditary disorders that are associated with poor absorption syndrome of glucose-galactose, fructose intolerance, sucrase-isomaltase deficiency.

Restrictions on use

Hypoproteinemia (including diseases that lead to its development), hyperkinesis, porphyria, organic diseases brain, open-angle glaucoma, bronchospastic syndrome, cerebral ataxia, renal failure, liver failure, spinal ataxia, heart failure, respiratory failure, tendency to abuse psychotropic drugs, sleep apnea (established or suspected), history of drug dependence, psychosis (paradoxical increase in symptoms), old age.

Use during pregnancy and breastfeeding

The use of chlordiazepoxide is contraindicated during pregnancy (especially in the first and third trimester) and breastfeeding. When using chlordiazepoxide in the first trimester of pregnancy, the risk of developing birth defects increases. When using chlordiazepoxide in the third trimester of pregnancy or in the perinatal period, the newborn may develop hypothermia, hypotension, respiratory failure, cardiac arrhythmia, and a weakened sucking reflex. When chlordiazepoxide is used during pregnancy, a significant change in fetal heart rate may occur. When chlordiazepoxide is used in obstetrics in doses that are recommended to facilitate childbirth, temporary hypothermia, muscle hypotension, and respiratory failure may develop in newborns, more often in premature infants. Infants whose mothers took benzodiazepines chronically during late pregnancy develop physical drug dependence and are at risk of developing withdrawal symptoms. If pregnancy is suspected or pregnancy is planned, the patient should stop taking chlordiazepoxide. Breastfeeding should be stopped during chlordiazepoxide therapy.

Side effects of chlordiazepoxide

Nervous system and sensory organs: drowsiness, dizziness, feeling tired, impaired concentration, lethargy, ataxia, dullness of emotions, headache, slowed mental reactions, euphoria, slowed motor reactions, depression, convulsions, tremor, memory loss, confusion, depressed mood, dystonic extrapyramidal reactions ( uncontrolled body movements, including the eyes), muscle weakness, weakness, dysarthria, paradoxical reactions (confusion, aggressive outbursts, hallucinations, irritability, acute agitation, nightmares, insomnia, anxiety), antegrade amnesia, blurred vision, diplopia.
Cardiovascular system and blood (hemostasis, hematopoiesis): decreased blood pressure, palpitations, tachycardia, chest pain, bradycardia, neutropenia, leukopenia, agranulocytosis (hyperthermia, chills, sore throat, unusual fatigue, unusual weakness), thrombocytopenia, increased bleeding, anemia.
Digestive system: dry mouth, heartburn, drooling, nausea, loss of appetite, vomiting, anorexia, intestinal motility disorders, intestinal colic, constipation, diarrhea, liver dysfunction, biliary dyskinesia, jaundice, increased activity of liver transaminases and alkaline phosphatase.
Respiratory system: bronchorrhea, difficulty breathing, bronchospasm.
Genitourinary system: impaired renal function, urinary retention, urinary incontinence, decreased libido, increased libido, dysmenorrhea.
Allergic reactions: itching, skin rash, drug-induced lupus erythematosus.
Others: drug dependence, addiction, weight loss, withdrawal syndrome (anxiety, headaches, muscle pain, irritability, confusion, derealization, hyperacusis, depersonalization, paresthesia in the limbs, light hypersensitivity, tactile hypersensitivity, epileptic seizures, hallucinations).

Interaction of chlordiazepoxide with other substances

Sleeping pills, antipsychotics (neuroleptics), tricyclic antidepressants, muscle relaxants, medications for anesthesia, narcotic analgesics, anticonvulsants, ethanol increase the inhibitory effect of chlordiazepoxide on the central nervous system.
Inducers of microsomal liver enzymes in joint use reduce the effectiveness of chlordiazepoxide. Phenytoin and phenobarbital accelerate the metabolism of chlordiazepoxide.
Inhibitors of microsomal liver enzymes (disulfiram, cimetidine, oral contraceptives), when used together, increase the concentration and prolong the effect of chlordiazepoxide due to inhibition of hepatic metabolism.
When chlordiazepoxide is used together with hormonal contraceptives, the effectiveness of chlordiazepoxide increases and the incidence of breakthrough bleeding increases.
Narcotic analgesics, when used together with chlordiazepoxide, increase euphoria, leading to increased mental dependence.
Chlordiazepoxide, when used together, reduces the effectiveness of levodopa in patients with parkinsonism.
Antacids, when used together, reduce the rate (but not the completeness of absorption) of chlordiazepoxide (the equilibrium concentration that is achieved with prolonged use of these drugs does not change).
Use chlordiazepoxide with caution in combination with other psychotropic medications. Chlordiazepoxide should not be co-administered with monoamine oxidase inhibitors and phenothiazines.
There are reports of the effect of chlordiazepoxide on blood coagulation in patients who take oral anticoagulants and chlordiazepoxide together (the consequences and cause of this interaction have not been established in clinical studies).
Antihypertensive drugs may increase the severity of the blood pressure reduction of chlordiazepoxide when used together.
Increased respiratory depression may occur when chlordiazepoxide and clozapine are used together.
When chlordiazepoxide and zidovudine are used together, the toxicity of the latter may increase.
Theophylline, which is used in low doses, when used together, reverses the sedative effect of chlordiazepoxide.
When chlordiazepoxide and phenytoin are used together, metabolism may be suppressed and the effect of the latter may be enhanced.
Rifampicin, carbamazepine, phenytoin, when used together, can accelerate the metabolism of chlordiazepoxide and weaken its effect.
Antiepileptic drugs used in conjunction with chlordiazepoxide may increase the undesirable effects and toxicity of chlordiazepoxide. If it is necessary to use antiepileptic drugs and chlordiazepoxide together, special care must be taken.
Particular caution is required when using chlordiazepoxide, especially at the beginning of therapy, in patients who have been receiving beta-blockers for a long time, centrally acting antihypertensive drugs, cardiac glycosides, anticoagulants, since the mechanisms and degree of drug interaction are unpredictable.
Alprazolam mutually enhances the depression of the central nervous system when used together with chlordiazepoxide.
Smoking may decrease the effect of chlordiazepoxide.
You can use other drugs together with chlordiazepoxide only after consulting your doctor to prevent possible drug interactions with chlordiazepoxide.

Overdose

Symptoms In case of an overdose of chlordiazepoxide, drowsiness, decreased reflexes, suppressed reflexes, lethargy, paradoxical excitation, depression of consciousness of varying degrees up to coma, dysarthria, nystagmus, ataxia, tremor, bradycardia, decreased blood pressure, decreased muscle tone, difficulty breathing, prolonged confusion, develop. disorientation, slurred speech, shortness of breath, severe weakness, depression of cardiac activity, depression of respiratory activity.
Treatment: induction of vomiting, immediate gastric lavage, administration activated carbon; intravenous administration of physostigmine or a specific benzodiazepine receptor antagonist - flumazenil (in a hospital setting), symptomatic treatment, intravenous infusion solutions (to enhance diuresis), ensuring adequate ventilation, maintaining blood pressure and respiration; for hypotension - administration of norepinephrine; monitoring of vital functions, control of cardiovascular and respiratory activity; If agitation develops, barbiturates should not be used. Hemodialysis is ineffective.

Trade names of drugs with the active substance chlordiazepoxide

Combined drugs:
Amitriptyline + Chlordiazepoxide: Amixide.