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Pharmacologic class: Benzodiazepine
Therapeutic class: Anxiolytic, sedative-hypnotic
Controlled substance schedule IV Pregnancy risk category D
Unknown. May potentiate effects of gamma-aminobutyric acid (an inhibitory neurotransmitter) by increasing neuronal membrane permeability; may depress CNS at limbic and subcortical levels of brain. Anxiolytic effect occurs at doses well below those that cause sedation or ataxia.
Capsules: 5 mg, 10 mg, 25 mg
Injection: 100-mg ampules
Indications and dosages
➣ Mild to moderate anxiety
Adults: 5 to 10 mg P.O. three to four times daily
➣ Severe anxiety
Adults: Initially, 50 to 100 mg I.M. or I.V.; then 25 to 50 mg P.O. three to four times daily as needed
➣ Preoperative apprehension or anxiety
Adults: 5 to 10 mg P.O. three to four times daily for several days before surgery or 50 to 100 mg I.M. 1 hour before surgery
➣ Acute alcohol withdrawal
Adults: Initially, 50 to 100 mg I.V. or I.M. Repeat dose as needed up to 300 mg/day.
• Hepatic impairment
• Age 65 or older
• Hypersensitivity to drug, other benzodiazepines, or tartrazine
• CNS depression
• Uncontrolled severe pain
• Pregnancy or breastfeeding
• Children younger than age 6
Use cautiously in:
• hepatic dysfunction, severe renal impairment
• debilitated or elderly patients.
• Dilute I.V. preparation with 5 ml of normal saline solution. Administer slowly over at least 1 minute.
• When giving I.M., use 2 ml of special I.M. diluent. Inject slowly and deeply into gluteus muscle.
• Don't use I.M. diluent for I.V. preparation.
• After I.V. or I.M. administration, observe patient closely and enforce bedrest for at least 3 hours.
CNS: dizziness, drowsiness, hangover, headache, depression, paradoxical stimulation
EENT: blurred vision
GI: nausea, vomiting, constipation, diarrhea
Other: physical or psychological drug dependence, drug tolerance, pain at I.M. site
Drug-drug. Antidepressants, antihistamines, opioids: additive CNS depression
Barbiturates, rifampin: decreased chlordiazepoxide efficacy
Cimetidine, disulfiram, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: enhanced chlordiazepoxide effect
Levodopa: decreased levodopa efficacy
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, bilirubin: increased levels
Granulocytes: decreased count
Metyrapone test: decreased response
Radioactive iodine uptake test (123I or 131I): decreased uptake
Urine 17-ketogenic steroids, urine 17-ketosteroids: altered test results
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use: increased CNS depression
• Monitor CBC and hepatic enzyme levels in prolonged therapy.
• Monitor renal and hepatic studies.
• Assess patient for apnea, bradycardia, and hypotension.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to avoid alcohol during therapy.
• Tell patient not to stop taking drug abruptly. Instruct him to discuss dosage-tapering schedule with prescriber.
• Caution female patient not to take drug if she's pregnant or might become pregnant during therapy. Advise her to use reliable contraception.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.