$Unique_ID{BRK03078} $Pretitle{} $Title{chlordiazepoxide and amitriptyline combination} $Subject{Limbitrol DS Roche Benzodiazepine antianxiety antidepressant chlordiazepoxide amitriptyline depression anxiety tricyclic antidepressants concentration chemicals nerve transmission brain depressant central nervous system brain spinal cord} $Volume{} $Log{} Copyright (C) 1993 Publications International, Ltd. chlordiazepoxide and amitriptyline combination ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) chlordiazepoxide and amitriptyline (various manufacturers) Limbitrol DS (Roche) TYPE OF DRUG Benzodiazepine antianxiety and antidepressant INGREDIENTS chlordiazepoxide and amitriptyline DOSAGE FORM Tablets (5 mg chlordiazepoxide and 12.5 mg amitriptyline; 10 mg chlordiazepoxide and 25 mg amitriptyline) STORAGE Chlordiazepoxide and amitriptyline combination tablets should be stored at room temperature in a tightly closed, light-resistant container. USES Chlordiazepoxide and amitriptyline combination is used for the treatment of depression associated with anxiety. Amitriptyline belongs to a group of drugs referred to as tricyclic antidepressants. These medicines are thought to relieve depression by increasing the concentration of certain chemicals necessary for nerve transmission in the brain. It is not clear exactly how chlordiazepoxide works, but it may relieve anxiety by acting as a depressant of the central nervous system (brain and spinal cord). TREATMENT This medication combination should be taken exactly as your doctor prescribes. In order to avoid stomach upset, you can take this medication with food or with a full glass of milk or water (unless your doctor directs you to do otherwise). Do not take chlordiazepoxide and amitriptyline tablets with a dose of antacids--they retard absorption of this medication. If you are taking this medication regularly and you miss a dose, take the missed dose as soon as possible, unless it is almost time for your next dose. In that case, do not take the missed dose at all; just return to your regular dosing schedule. Do not double the dose. The benefits of therapy with this medication may not become apparent for two or three weeks. SIDE EFFECTS Minor. Agitation, anxiety, blurred vision, confusion, constipation, cramps, diarrhea, dizziness, drowsiness, dry mouth, fatigue, headache, heartburn, insomnia, loss of appetite, nausea, peculiar tastes in the mouth, restlessness, sweating, vomiting, weakness, or weight gain or loss. These side effects should disappear as your body adjusts to the medication. This drug may cause increased sensitivity to sunlight, so avoid prolonged exposure to sunlight and sunlamps. Wear protective clothing and sunglasses, and use an effective sunscreen. Amitriptyline may cause the urine to turn blue-green. This is a harmless effect. Dry mouth can be relieved by chewing sugarless gum or you may choose to suck on ice chips or a piece of hard candy. To relieve constipation, increase the amount of fiber in your diet (fresh fruits and vegetables, salads, bran, whole-grain breads), exercise, and drink more water (unless your doctor directs you to do otherwise). To avoid dizziness or light-headedness when you stand, contract and relax the muscles of your legs for a few moments before rising. Do this by pushing one foot against the floor while raising the other foot slightly, alternating feet so that you are "pumping" your legs in a pedaling motion. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about chest tightness, convulsions, difficult or painful urination, enlarged or painful breasts (in both sexes), fainting, fever, fluid retention, hair loss, hallucinations, impotence, mood changes, mouth sores, nervousness, nightmares, numbness in the fingers or toes, palpitations, ringing in the ears, skin rash, sore throat, tremors, uncoordinated movements or balance problems, unusual bleeding or bruising, or yellowing of the eyes or skin. INTERACTIONS Chlordiazepoxide and amitriptyline combination interacts with several other types of medications: 1. Extreme drowsiness can occur when this medicine is taken with central nervous system depressants (such as alcohol, antihistamines, barbiturates, other benzodiazepine tranquilizers, muscle relaxants, narcotics, pain medications, phenothiazine tranquilizers, and sleeping medications) or with other antidepressants. 2. Amitriptyline may decrease the effectiveness of antiseizure medications and may block the blood-pressure-lowering effects of clonidine and guanethidine. 3. Estrogen-containing drugs and oral contraceptives (birth control pills) can increase the side effects and reduce the effectiveness of amitriptyline. 4. Amitriptyline may increase the side effects of thyroid medication and over-the-counter (nonprescription) cough, cold, allergy, asthma, sinus, and diet medications. 5. The concurrent use of amitriptyline and monoamine oxidase (MAO) inhibitors should be avoided because the combination may result in fever, convulsions, or high blood pressure. At least 14 days should separate the use of this drug and the use of an MAO inhibitor. 6. Chlordiazepoxide may decrease the effectiveness of levodopa and oral anticoagulants (blood thinners) and may increase the effects of phenytoin. 7. Disulfiram, oral contraceptives (birth control pills), isoniazid, and cimetidine can increase the blood levels of chlordiazepoxide, which could possibly lead to toxic effects. 8. Concurrent use of rifampin may decrease the effectiveness of chlordiazepoxide and amitriptyline. 9. Cimetidine can decrease the elimination of amitriptyline from the body, which can increase the possibility of side effects. BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially any of the medications that are listed above. WARNINGS * Tell your doctor about unusual or allergic reactions you have had to any medications, especially to chlordiazepoxide or other benzodiazepine tranquilizers (such as alprazolam, clorazepate, diazepam, flurazepam, halazepam, lorazepam, oxazepam, prazepam, temazepam, and triazolam), or to amitriptyline or other tricyclic antidepressants (such as desipramine, imipramine, nortriptyline, or doxepin). * Tell your doctor if you have a history of alcoholism or if you have ever had asthma, high blood pressure, liver or kidney disease, lung disease, myasthenia gravis, heart disease, a heart attack, circulatory disease, stomach problems, intestinal problems, difficulty in urinating, enlarged prostate gland, epilepsy, glaucoma, thyroid disease, mental illness, or electroshock therapy. * If this drug makes you dizzy or drowsy, do not take part in any activity that requires alertness, such as driving a car or operating potentially dangerous equipment. * Before having surgery or any other medical or dental treatment, be sure to tell your doctor or dentist that you are taking this medication. * The effects of this medication may last as long as seven days after you have stopped taking it. It is therefore important that you continue to observe all precautions during this period. * This medication has the potential for abuse and must be used with caution. Tolerance develops quickly; do not increase the dosage of the drug unless you first consult your doctor. It is also important not to stop taking this drug suddenly, especially if it has been used in large amounts or has been used for longer than several weeks. Abruptly stopping this medication may cause nausea, headache, stomach upset, fatigue, or a worsening of your condition. Your doctor may want to reduce the dosage gradually. * Be sure to tell your doctor if you are pregnant. Chlordiazepoxide may increase the chance of birth defects if it is taken during the first three months of pregnancy. In addition, too much use of this medication during the last six months of pregnancy may lead to addiction of the fetus, resulting in withdrawal symptoms in the newborn. Use of this medication during the last weeks of pregnancy may cause excessive drowsiness, slowed heartbeat, and breathing difficulties in the newborn infant. Also, tell your doctor if you are breast-feeding an infant. This medicine may pass into breast milk and cause excessive drowsiness, slowed heartbeat, breathing difficulty, and irritability in the nursing infant. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.