Chlordiazepoxide and Amitriptyline (Oral)

Amitriptyline and chlordiazepoxide are used in combination to produce a desirable effect on certain chemicals in the brain, which may be out of balance and causing depression in a person.

Overview

The two drugs amitriptyline and chlordiazepoxide work effectively together as a single medication for the treatment of patients suffering from severe anxiety or depression. It is thought that certain imbalances of specific chemicals may exist in the brain, and this combination medication acts on other brain chemicals to counteract that deficiency.

The intended effect of using this combination medication is to produce a more positive mood in the patient, and a greater feeling of well-being that will help to ward off the more negative moods which might otherwise prevail. By affecting the balance of certain neurotransmitters in the brain, this medication can help to restore a person's outlook on life to a more even keel.

In people under the age of 25, there have been reports of a worsening of the depressed state that a patient was in before taking the drug, but these are not common, and appear to be limited to the demographic of adolescents and young adults. In older adults, the combination drug has a clinical success rate which is very impressive for managing the effects of anxiety and depression.

Condition Treated

  • Anxiety and depression.

Type of Medicine

  • Amitriptyline - tricyclic anti-depressant; chlordiazepoxide - benzodiazepine

Side Effects

Along with its beneficial effects in managing anxiety and depression, amitriptyline and chlordiazepoxide may also produce some unwanted side effects in patients being treated with the drug. The side effects themselves can be broken down into several categories, along the lines of the severity of each, and how they should be handled.

The first severe side effect to take note of is that of an allergic reaction, because the symptoms it produces can actually be life-threatening if they go untreated, and tend to worsen over a period of time. An allergic reaction to the drug will be identifiable by a pronounced swelling in the facial area, or in the lips, tongue, and throat, which will become very uncomfortable for the patient, and can lead to some very serious consequences. If you should experience these side effects after taking the medication, contact your doctor immediately, and if your doctor is unavailable, you should seek emergency medical attention right away.

Other side effects which are considered severe in nature, and for which you should contact your doctor immediately, include the following:

  • trouble with sleeping
  • irregular heartbeat
  • worsening depression
  • shakiness or trembling
  • unusual nervousness or irritability
  • confusion or disorientation
  • hallucinations that involve feeling, hearing, or seeing things which are not sensed by others
  • blurred vision, double vision, or abrupt changes in vision
  • pain around the eyes
  • persistent constipation
  • difficulties with urination
  • seizures or convulsions
  • yellowish tinge to the skin or around the eyes
  • fever and or sore throat
  • skin rashes and itching
  • hypersensitivity to sunlight.

The symptoms in this class of side effects are often attributed to overdosing on the drug, and if you or someone you know exhibits these side effects, you should immediately seek emergency medical attention:

  • severe nausea and vomiting
  • rigid or stiff muscles
  • hallucinations
  • high fever and sore throat
  • irregular or very fast heartbeat
  • extreme agitation
  • confusion or disorientation
  • seizures and/or convulsions
  • severe lightheadedness or dizziness
  • strong sense of fatigue or weakness
  • enlarged pupils.

There are some side effects associated with usage of amitriptyline and chlordiazepoxide which are considered relatively mild and do not require any kind of medical attention. Side effects in this class will generally subside on their own and fade away completely within a few days, as the body adapts itself to the medication being used. If any the side effects appearing on this list should become troublesome enough to the patient that some kind of medical attention is indicated, the family doctor may have recommendations on how to lessen these side effects or eliminate them altogether with some program of treatment.

  • Bloated or full feeling
  • unexplained weight gain
  • persistent headaches
  • dry mouth
  • unpleasant aftertaste in the mouth at almost any time
  • drowsiness or fatigue
  • dizziness or lightheadedness
  • diarrhea
  • temporary clumsiness or unsteadiness
  • nausea and/or vomiting
  • unusual weakness at various times.

Once you have finished taking the full duration of your prescribed medication, there are still some side effects which may appear in the weeks immediately after your program of treatment. You should contact your doctor at the earliest possible opportunity if any of the side effects on this list are manifested:

  • pronounced trembling or shakiness
  • stomach cramps or pains
  • muscle cramping or pains
  • extreme irritability or restlessness
  • profuse sweating
  • seizures or convulsions
  • strong headaches
  • difficulty sleeping
  • nightmares or hallucinations.

Dosage

The dosages listed below are not meant to be considered a recommended dosage for any specific patient, but are instead standard dosages used for the treatment of either anxiety or depression. Your doctor will recommend a specific dosage for you which will be based on several factors, including the medical condition you are being treated for, your age at the time of treatment, the strength of the medication itself, and the frequency of administration for the medication.

Adults who are being treated for anxiety would normally be given an initial dosage of 3 to 4 tablets per day, and these should be taken in divided doses. To establish a maintenance dosage, a patient would be given between 2 and 6 tablets each day, these to be taken orally in divided doses. The maximum number of tablets which any patient should take for the treatment of anxiety is 6 tablets per day, and this assumes a tablet composition of 10 mg of chlordiazepoxide, in tandem with 25 mg of amitriptyline.

Your doctor's recommended dosage will always be the lowest possible amount which is capable of achieving a desirable effect in the reduction of anxiety symptoms. It is allowable to take your medication at bedtime, and for those patients who are taking a single dosage per day, bedtime is the optimal time for scheduling ingestion of the medication.

When treating adults suffering from depression, the same combination tablets should be used, having a ratio of 10 mg of chlordiazepoxide to 25 mg of amitriptyline. The initial dosage in the treatment of depression should be either 3 or 4 tablets orally ingested, and split up into equal dosages during the day. A maintenance dosage should be between 2 and 6 six tablets during the day, taken orally and divided into equal doses, several times throughout the course of the day.

It is uncommon for any more than 6 tablets of the combination drug to be prescribed by doctors for the treatment of depression. The specific amount of medication prescribed by your doctor will always be the lowest possible amount which can achieve positive benefits in managing your depression symptoms. As with the treatment of anxiety, tablets of this combination drug used to treat depression can be ingested at bedtime, and for single dosage patients, bedtime is the preferred time of day.

If you should miss a dosage either for anxiety or for depression, take it as soon as you remember to, unless it has grown close to the time of your next regularly scheduled dosage. In this case, skip the dosage which you missed, and simply wait until it's time for your next dose. Do not double up on doses in order to get back on schedule, since this is much riskier than simply missing one dose.

If you suspect that you have ingested too much amitriptyline and chlordiazepoxide medication, call the poison control center or your local emergency room immediately. Some of the symptoms associated with overdosing include very shallow breathing, and an inability to wake up. An overdose victim may even appear to be in a coma-like state, which is a situation calling for immediate medical attention.

Interactions

Amitriptyline and chlordiazepoxide have the potential to interact with other medications, with certain foods and drink, and even with medical conditions other than anxiety or depression. This makes it necessary to be aware of what the possible interactions might be with each of those substances, so that any dangerous reactions can be avoided.

When you consult with your doctor about the possibility of taking amitriptyline and chlordiazepoxide, it's a good idea to compose a list of all other medications which you are currently taking. This should include prescription drugs, over-the-counter drugs, vitamins, and herbal supplements, as well as all of the dosages for each of these. This will give your doctor a chance to review the entire roster of other medications you're taking, so that he can avoid any dangerous combinations.

This list can also be used in the event that you have to visit an emergency room, or some kind of health clinic for treatment of some other medical condition. Any doctor at such a clinic who is not your primary care doctor, will need to be able to review your medications and dosages, so that some kind of treatment can safely be prescribed for you.

You should not drink alcohol when taking amitriptyline and chlordiazepoxide, because the sedative effect of alcohol can multiply the sedative effect of your medication and create a dangerous condition of drowsiness. If you happen to be driving or operating machinery soon after drinking alcohol and taking your medication, it is very possible that you could lose concentration and be involved in an accident.

Some of the medications that you should avoid taking concurrently with amitriptyline and chlordiazepoxide are the following:

cimetidine and quinidine either of these drugs has the capability of increasing the level of amitriptyline circulating throughout your body, and this could have some very dangerous side effects. In addition to dizziness or lightheadedness, you could also experience confusion, and in a worst-case scenario, possibly even a heart attack.
Propafenone and flecainide: ingesting these drugs at the same time as amitriptyline and chlordiazepoxide could produce either an irregular heartbeat, or a pounding kind of heartbeat which is excessively rapid for the body.
Selegiline, tranylcypromine, and phenelzine: taking any of these drugs in tandem with chlordiazepoxide and amitriptyline could trigger convulsions or seizures in a patient, as well as fevers which can become dangerously high. It is even possible for this condition to prove fatal if not immediately handled by a qualified medical person.
Paroxetine, fluoxetine, and sertralin if any of these drugs are taken concurrently with amitriptyline and chlordiazepoxide, they can have the effect of multiplying the normal side effects that would otherwise have been manifested. The worst of these side effects could be extreme disorientation, dizziness, or a potentially fatal heart attack.

There are other medications which, when taken concurrently with amitriptyline and chlordiazepoxide can have the effect of multiplying the side effects which you would normally have experienced just by taking your medication. Any of the medications on this list could act in the body to increase the levels of amitriptyline and chlordiazepoxide in your body, which accounts for the multiplication of the side effects which would then appear.

Topiramate: some of the side effects which can be enhanced when taking this drug in conjunction with your normal medication are a much deeper drowsiness, greater confusion and dizziness, and a more profound constipation. If it is medically necessary to take topiramate in tandem with your amitriptyline and chlordiazepoxide, your doctor will more than likely reduce your dosage of one or the other, so that the multiplication of side effects is lessened.
Opioids such as codeine, oxycodone, or hydrocodon taking any of these drugs in conjunction with your amitriptyline and chlordiazepoxide medication puts you at severe risk of a powerful drowsiness, greatly depressed respiratory function, possible coma, and even death. It is very uncommon for physicians to prescribe opioids in tandem with amitriptyline and chlordiazepoxide because of the potential for fatality, or other extreme side effects.

Warnings

There are certain warnings or precautions which should be observed when taking amitriptyline and chlordiazepoxide, because there may be negative impacts which result. Before taking this drug, you should consult with your doctor or pharmacist, and discuss your entire medical history especially, as it relates to any of the following:

  • angle closure glaucoma
  • excessive bleeding issues
  • respiratory or lung problems
  • kidney disease or kidney problems
  • diabetes of either type
  • liver disease or liver problems
  • heart conditions such as irregular heartbeat, heart attack, chest pains, etc.
  • any kind of difficulty urinating due to chronic constipation, overactive thyroid, or enlarged prostate
  • any personal history or family history of substance abuse relative to alcohol or drugs
  • family history or personal history of mental disorders, e.g. bipolar disorder, psychosis
  • personal or family history of convulsions or seizures
  • thoughts of suicide or self abuse
  • conditions which may increase the risk of seizures, such as alcohol withdrawal, brain injury, tumors, or brain disease.

It is possible that using amitriptyline and chlordiazepoxide can create a situation which has an impact on your heart's normal rhythm, which is referred to as QT prolongation. It is possible, although very rare, that QT prolongation can trigger extremely dangerous conditions such as dizziness, fainting, or even death. The potential for a QT prolongation situation to develop is increased for patients who have a history of heart problems, slow heartbeat, or any family history of cardiac issues. The risk for triggering QT prolongation is also increased in patients who persistently have low levels of magnesium or pet potassium in their bloodstream, and this can be caused by taking diuretics, by profuse sweating, by persistent diarrhea, or by frequent nausea and vomiting.

It is very possible that taking amitriptyline and chlordiazepoxide can cause you to become drowsy or disoriented, and in some cases, can trigger blurry vision. For this reason, it is not advisable to be driving after taking the medication, or to be operating any kind of machinery.

Taking this medication can also cause you to be hypersensitive to sunlight, so it would be prudent to avoid excessive exposure to direct sun, and to avoid sunlamps or tanning booths. When you have to be outdoors, it is advisable to wear protective clothing, sunglasses, and sunscreen to shield yourself from direct sunlight. If you do develop a sunburn or any kind of blistering from exposure to sunlight, you should notify your doctor immediately and seek medical treatment.

It will be harder to control your sugar levels if you are a diabetic who uses amitriptyline and chlordiazepoxide, so it will be necessary to monitor your blood sugar levels more closely. You should maintain an ongoing discussion with your doctor about this monitoring, in case any adjustments are necessary to your dosage levels.

Before having any kind of surgery, including oral surgery, you should notify your doctor or dentist that you are taking amitriptyline and chlordiazepoxide, as well as all other medications which you are currently taking. It may be necessary to discontinue ingestion of some or all of your drugs prior to your scheduled surgery.

Amitriptyline and chlordiazepoxide are not recommended for women who are currently pregnant or plan to become pregnant, since it has the potential to harm an unborn fetus. If you should become pregnant while taking this drug, immediately seek counsel with your doctor so that the risks of continued ingestion can be weighed against the positive medical benefits which might be achieved.

It is known that amitriptyline and chlordiazepoxide are passed in breast milk to infants, and it is also known that at least some minor negative impacts are felt by the infant. It is therefore inadvisable to breast-feed infants while concurrently taking amitriptyline and chlordiazepoxide.

Storage

Your combination amitriptyline and chlordiazepoxide medication should always be stored at a location which is maintained at approximately 77°F (which equates to 25°C), and is well away from direct light or excessive humidity. Moisture may degrade the effectiveness of the medication, and that means that it should not be stored in a bathroom medicine cabinet, because there are conditions of the bathroom which frequently generate high humidity and high temperatures which can degrade the medicine.

It is allowable to briefly store the medication at temperatures as low as 59° or as high as 86°F (equating to between 15 and 30°C), but this should be avoided for any significant duration. Your medication should always be kept well out of the reach of all pets and young children, preferably in a location which is so high that children cannot reach it even by climbing on furniture.

Unused medication should not be flushed down the toilet, or poured down the sink unless you are advised to do so by a pharmacist or your family doctor. Proper disposal methods should always be used for any medication which has expired, or which will not be used. If you cannot get recommendations from your pharmacist or your doctor about proper disposal methods, you can consult the FDA website which recommends disposal methods for many the most common drugs.

Your medication should not be kept in a pill reminder container, especially one which is within reach of any children who might be in the household. These containers almost never have safety features on them which prevent access, or which lock down the covers to keep contents inaccessible. Children have been known to break into these and ingest the contents simply because they are attracted by the shape or the color of the container itself.

Summary

Amitriptyline and chlordiazepoxide are taken together as a medication for the treatment of anxiety or depression, or both. While adolescents and young adults may be at risk for developing feelings of greater depression, all age groups above 25 are more likely to experience mostly positive results from taking the drug.

It is easily administered in a single tablet, which typically is comprised of 10 mg of chlordiazepoxide and 25 mg of amitriptyline. While there are some potential side effects associated with using this combination drug, they are not often severe, and are generally outweighed by the very positive effects brought about.

There are not a lot of other drugs which interact with this combination drug, but the ones which do interact should be carefully avoided, as there is a potential for some of these to produce fairly serious reactions in a patient.