Amitriptyline and Chlordiazepoxide

Amitriptyline and Chlordiazepoxide Brand Name– Limbitrol | Limbitrol DS

What is Amitriptyline and Chlordiazepoxide

Amitriptyline and chlordiazepoxide are used together in an oral preparation to treat depression associated with moderate to severe anxiety.

Amitriptyline is a tricyclic antidepressant agent used to treat depression. Chlordiazepoxide is a benzodiazepine agent used for anxiety.

Doses of each ingredient should be titrated and individualized. If the optimal dose corresponds to the ratio contained in the combination drug, this product can be used for convenient dosing.

In a 28-day, randomized, blinded, comparative trial (n=434), patients received either 25 mg amitriptyline; 10 mg chlordiazepoxide PO (Limbitrol) or amitriptyline (25 mg PO) at bedtime as a single daily dose. The dose was titrated to a maximum of 4 capsules per night.

Both groups showed significant improvement at each visit and significantly more patients improved after 7 days in the amitriptyline; chlordiazepoxide group. There was no significant difference in adverse effects between groups.

Amitriptyline and chlordiazepoxide was initially approved by the FDA in December, 1977.

Indications

  • anxiety
  • depression

For the treatment of moderate to severe depression with concurrent symptoms of moderate to severe anxiety in adult patients

Side Effects

  1. abdominal pain
  2. amnesia
  3. anorexia
  4. ataxia
  5. blurred vision
  6. breast enlargement
  7. cardiomyopathy
  8. confusion
  9. constipation
  10. cycloplegia
  11. depression
  12. diarrhea
  13. dizziness
  14. drowsiness
  15. EEG changes
  16. ejaculation dysfunction
  17. elevated hepatic enzymes
  18. erythema
  19. euphoria
  20. fatigue
  21. fever
  22. galactorrhea
  23. gynecomastia
  24. hallucinations
  25. heart failure
  26. hypertension
  27. hyponatremia
  28. ileus
  29. impaired cognition
  30. impotence (erectile dysfunction)
  31. jaundice
  32. lethargy
  33. libido decrease
  34. libido increase
  35. mania
  36. menstrual irregularity
  37. mydriasis
  38. myocardial infarction
  39. nausea
  40. neuroleptic malignant syndrome-like symptoms
  41. ocular hypertension
  42. orthostatic hypotension
  43. palpitations
  44. paresthesias
  45. photosensitivity
  46. physiological dependence
  47. PR prolongation
  48. pruritus
  49. pseudoparkinsonism
  50. psychological dependence
  51. purpura
  52. QT prolongation
  53. restlessness
  54. seizures
  55. serotonin syndrome
  56. SIADH
  57. stroke
  58. suicidal ideation
  59. syncope
  60. teratogenesis
  61. testicular swelling
  62. tolerance
  63. torsade de pointes
  64. tremor
  65. urinary retention
  66. urticaria
  67. vasculitis
  68. ventricular tachycardia
  69. visual impairment
  70. vomiting
  71. weight gain
  72. withdrawal
  73. xerostomia

Monitoring Parameters

  • blood pressure
  • CBC
  • ECG
  • heart rate
  • LFTs
  • serum amitriptyline concentrations
  • thyroid function tests (TFTs)
  • weight

Contraindications

  • abrupt discontinuation
  • acute myocardial infarction
  • agranulocytosis
  • alcoholism
  • anticholinergic medications
  • asthma
  • AV block
  • benzodiazepine dependence
  • benzodiazepine hypersensitivity
  • biliary cirrhosis
  • bipolar disorder
  • breast-feeding
  • bundle-branch block
  • carbamazepine hypersensitivity
  • cardiac arrhythmias
  • cardiac disease
  • children
  • chronic obstructive pulmonary disease (COPD)
  • closed-angle glaucoma
  • CNS depression
  • coadministration with other CNS depressants
  • coma
  • constipation
  • contact lenses
  • dementia
  • depression
  • diabetes mellitus
  • driving or operating machinery
  • ethanol ingestion
  • ethanol intoxication
  • gastroesophageal reflux disease (GERD)
  • geriatric
  • GI disease
  • GI obstruction
  • head trauma
  • heart failure
  • hematological disease
  • hepatic disease
  • hepatic encephalopathy
  • hepatitis
  • hyperthyroidism
  • hypothyroidism
  • ileus
  • increased intraocular pressure
  • labor
  • mania
  • MAOI therapy
  • myasthenia gravis
  • neonates
  • neuromuscular disease
  • obstetric delivery
  • Parkinson’s disease
  • porphyria
  • pregnancy
  • prostatic hypertrophy
  • psychosis
  • pulmonary disease
  • QT prolongation
  • radiographic contrast administration
  • renal failure
  • renal impairment
  • respiratory depression
  • schizophrenia
  • seizure disorder
  • seizures
  • shock
  • sleep apnea
  • status epilepticus
  • stroke
  • substance abuse
  • suicidal ideation
  • sunlight (UV) exposure
  • surgery
  • thrombocytopenia
  • thyroid disease
  • tobacco smoking
  • tricyclic antidepressant hypersensitivity
  • urinary retention

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  • Telithromycin
  • Telotristat Ethyl
  • Temazepam
  • Terbinafine
  • Terfenadine
  • Tetrabenazine
  • Tetracaine
  • Thalidomide
  • Theophylline, Aminophylline
  • Thiethylperazine
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Thyroid hormones
  • Tiagabine
  • Tipranavir
  • Tizanidine
  • tobacco
  • Tolcapone
  • Tolterodine
  • Topiramate
  • Toremifene
  • Tramadol
  • Trandolapril; Verapamil
  • Trazodone
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trihexyphenidyl
  • Trimethobenzamide
  • Triprolidine
  • Triptorelin
  • Trospium
  • Tucatinib
  • Valerian, Valeriana officinalis
  • Valproic Acid, Divalproex Sodium
  • Vandetanib
  • Vardenafil
  • Vasopressin, ADH
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Verteporfin
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Vorinostat
  • Vortioxetine
  • Warfarin
  • Yohimbine
  • Zafirlukast
  • Zaleplon
  • Ziconotide
  • Zileuton
  • Ziprasidone
  • Zolpidem
  • Zonisamide
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