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chlordiazepoxide/ amitriptyline
generic
Black Box Warnings .
Suicidality
incr. suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in pts >24 yo, and risk decr. in pts 65 yo and older; depression and certain other psychiatric disorders themselves assoc. w/ incr. suicide risk; observe all pts for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication w/ prescriber; not approved for peds use
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 5 mg/12.5 mg, 10 mg/25 mg
depression w/ anxiety, moderate-severe
- [20 mg/50 mg/day-60 mg/150 mg/day PO in divided doses]
- Start: 15 mg/37.5 mg/day-40 mg/100 mg/day PO in divided doses; Info: use lower doses in elderly pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [see below]
- CrCl <10: decr. usual dose by 50%; Info: metabolite accumulation possible
- HD: decr. usual dose by 50%; no supplement after dialysis; PD: decr. usual dose by 50%; no supplement; Info: metabolite accumulation possible
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.