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chlordiazepoxide
generic
Black Box Warnings .
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: CAP: 5 mg, 10 mg, 25 mg
anxiety, mild-moderate
- [5-10 mg PO tid-qid]
- Info: start 5 mg PO qd-bid, then gradually incr. to 5 mg PO bid-qid in elderly or debilitated pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
anxiety, severe
- [20-25 mg PO tid-qid]
- Info: start 5 mg PO qd-bid, then gradually incr. to 5 mg PO bid-qid in elderly or debilitated pts; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
preoperative anxiety
- [5-10 mg PO tid-qid]
- Info: start 5 mg PO qd-bid in elderly or debilitated pts
alcohol withdrawal, acute
- [fixed-dose regimen]
- Dose: 25-100 mg PO q4-6h x1 day, then 25-100 mg PO q6-8h x1 day, then 25-100 mg PO q8-12h x1 day, then 25-100 mg PO qhs for up to 2 days; Max: 300 mg/day; Info: start 50-100 mg PO q1-2h x3 doses if high-risk or severe withdrawal; give additional doses prn; refer to institution protocol
- [symptom-triggered regimen]
- Dose: 25-100 mg PO prn; Max: 300 mg/day; Info: dose and frequency determined by sx severity; start 50-100 mg PO q1-2h prn if high-risk or severe withdrawal; refer to institution protocol
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 .
- Dosage forms: CAP: 5 mg, 10 mg, 25 mg
anxiety
- [6 yo and older]
- Dose: 5 mg PO bid-qid; Start: 5 mg PO bid; Info: may incr. dose to 10 mg bid-tid; taper dose gradually to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised