Libritabs


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chlordiazePOXIDE

(klor-dye-az-e-pox-ide) ,

Libritabs

(trade name),

Librium

(trade name)

Classification

Therapeutic: antianxiety agents
Pharmacologic: benzodiazepines
Pregnancy Category: D

Indications

Adjunct management of anxiety.Treatment of alcohol withdrawal.Adjunct management of anxiety associated with acute myocardial infarction.

Action

Acts at many levels of the CNS to produce anxiolytic effect.
Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Therapeutic effects

Sedation.
Relief of anxiety.

Pharmacokinetics

Absorption: Well absorbed from the GI tract.
Distribution: Widely distributed. Crosses the blood-brain barrier. Crosses the placenta; enters breast milk. Recommend to discontinue drug or bottle feed.
Metabolism and Excretion: Highly metabolized by the liver. Some products of metabolism are active as CNS depressants.
Half-life: 5–30 hr.

Time/action profile (sedation)

ROUTEONSETPEAKDURATION
PO1–2 hr0.5–4 hrup to 24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Some products contain tartrazine and should be avoided in patients with known intolerance;Cross-sensitivity with other benzodiazepines may occur;Comatose patients or those with pre-existing CNS depression;Uncontrolled severe pain;Pulmonary disease;Angle-closure glaucoma;Porphyria; Obstetric / Lactation: May cause CNS depression, flaccidity, feeding difficulties, and weight loss in infants; Pediatric: Children ≤6 yr.
Use Cautiously in: Hepatic dysfunction;Severe renal impairment;History of suicide attempt or substance abuse; Geriatric: Long-acting benzodiazepines cause prolonged sedation in the elderly. Appears on Beers list and is associated with increased risk of falls (↓ dose required or consider short-acting benzodiazepine);Debilitated patients (initial dose ↓ required).

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • drowsiness (most frequent)
  • hangover
  • headache
  • mental depression
  • paradoxical excitation
  • sedation

Ear, Eye, Nose, Throat

  • blurred vision

Gastrointestinal

  • constipation
  • diarrhea
  • nausea
  • vomiting
  • weight gain

Dermatologic

  • rashes

Miscellaneous

  • physical dependence
  • psychological dependence
  • tolerance

Interactions

Drug-Drug interaction

Alcohol, antidepressants, antihistamines, and opioid analgesics —concurrent use results in additive CNS depression.Cimetidine, oral contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, propranolol, or valproic acid may enhance effects.May ↓ efficacy of levodopa.Rifampin or barbiturates may ↓ effectiveness of chlordiazepoxide.Sedative effects may be ↓ by theophylline.Concomitant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression.

Route/Dosage

Oral (Adults) Alcohol withdrawal—50–100 mg, repeated until agitation is controlled (up to 400 mg/day). Anxiety—5–25 mg 3–4 times daily.
Oral (Geriatric Patients or Debilitated Patients) Anxiety—5 mg 2–4 times daily initially, increased as needed.
Oral (Children >6 yr) Anxiety—5 mg 2–4 times daily, up to 10 mg 2–3 times daily.

Availability (generic available)

Capsules: 5 mg, 10 mg, 25 mg

Nursing implications

Nursing assessment

  • Assess for anxiety and level of sedation (ataxia, dizziness, slurred speech) periodically during therapy.
    • Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically during therapy.
    • Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict the amount of drug available to patient.
    • Geriatric: Assess risk of falls and institute fall prevention strategies.
  • Alcohol Withdrawal: Assess for tremors, agitation, delirium, and hallucinations. Protect patient from injury. Institute seizure precautions.
  • Lab Test Considerations: Patients on prolonged therapy should have CBC and liver function tests evaluated periodically. May cause ↑ in serum bilirubin, AST, and ALT.
    • May alter results of urine 17-ketosteroids and 17-ketogenic steroids. May cause ↓ response on metyrapone tests and decreased thyroidal uptake of 123I and 131I.
  • Flumazenil reverses sedation caused by chlordiazepoxide toxicity or overdose. (Flumazenil may induce seizures in patients with a history of seizure disorder or who are on tricyclic antidepressants.)

Potential Nursing Diagnoses

Anxiety (Indications)
Risk for injury (Side Effects)
Dysfunctional family processes: alcoholism

Implementation

  • Do not confuse chlordiazepoxide with chlorpromazine.
  • Oral: Administer after meals or with milk to minimize GI irritation. Tablets may be crushed and taken with food or fluids if patient has difficulty swallowing. Administer greater dose at bedtime to avoid daytime sedation. Do not discontinue abruptly; taper by 10 mg every 3 days to reduce chance of withdrawal effects. Some patients may require longer taper period (months). Monitor patients closely with seizure disorder as abrupt withdrawal may precipitate seizures.

Patient/Family Teaching

  • Instruct patient to take chlordiazepoxide as directed. If medication is less effective after a few weeks, check with health care professional; do not increase dose. Medication should be tapered at the completion of long-term therapy. Sudden cessation of medication may lead to withdrawal (insomnia, irritability, nervousness, tremors).
  • Advise patient not to share medication with others; may be dangerous.
  • May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to avoid the use of alcohol and other CNS depressants concurrently with this medication.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional prior to taking any Rx, OTC, vitamins, or herbal products.
  • Instruct patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.

Evaluation/Desired Outcomes

  • Decreased sense of anxiety.
    • Increased ability to cope.
  • Decreased delirium tremens and more rational ideation when used for alcohol withdrawal.

Libritabs

a trademark for an antianxiety agent (chlordiazepoxide hydrochloride).