Indications for Chlordiazepoxide/Amitriptyline HCl:
Moderate-to-severe depression associated with moderate-to-severe anxiety.
Individualize. Initially 3–4 tabs daily in divided doses (with largest portion taken at bedtime). 10mg/25mg tabs: may be increased to 6 tabs daily. Elderly: reduce dose.
During or within 14 days of MAOIs. Acute post MI.
Risks from concomitant use with opioids; see Interactions. Monitor closely for clinical worsening, suicidality, or unusual changes in behavior. Activation of mania/hypomania; screen patients for bipolar disorder. Discontinue several days before surgery. History of urinary retention, seizures, angle-closure glaucoma. Cardiovascular disorders. Hyperthyroidism. Renal or hepatic impairment. Monitor LFTs and CBCs with long-term therapy. Avoid abrupt cessation. Write Rx for smallest practical amount. Elderly. Debilitated. Pregnancy (during the 1st trimester), nursing mothers: not recommended.
Benzodiazepine + tricyclic.
See Contraindications. Hyperpyretic crisis, severe convulsions, and death with MAOIs. Increased sedation, respiratory depression, coma, and death with concomitant opioids; reserve use in those for whom alternative treatment options are inadequate; if needed, limit dosages/durations to minimum and monitor. Concomitant CYP2D6 inhibitors: may need to adjust dose. During or within 5 weeks of fluoxetine: not recommended. Potentiated by cimetidine, topiramate. Potentiates CNS depression with alcohol, other CNS depressants. Caution with concomitant SSRIs, ECT. May block antihypertensives (eg, guanethidine).
Drowsiness, dry mouth, constipation, blurred vision, dizziness, bloating, vivid dreams, impotence, tremor, confusion, nasal congestion; rare: granulocytopenia, jaundice, hepatic dysfunction. MI, stroke, arrhythmias, sinus tachycardia, prolongation of conduction time possible with high doses.
Formerly known under the brand names Limbitrol, Limbitrol DS.