Select therapeutic use:
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.
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).
Benzodiazepine + tricyclic.
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.