Chlordiazepoxide-oral

Yes

Adults

• For the treatment of mild to moderate anxiety disorders or symptoms: 5 to 10 mg by mouth 3-4 times daily.
• For the treatment of severe anxiety disorders or symptoms: 20 to 25 mg by mouth 3-4 times daily.
• For the management of preoperative apprehension and anxiety: 5 to 10 mg by mouth 3-4 times daily on days preceding surgery.

Dosing: Pediatrics

• For the treatment of anxiety symptoms in children = 6 years to adolescents the usual daily recommended dose is 5 mg 2-4 times daily.
• Dosage may be increased to 10 mg per day given in 2-3 divided doses if necessary.
• Chlordiazepoxide is not recommended for use in children below the age of 6 years.

Dosing: Geriatric patients

• The usual recommended dose is 5 mg 2 to 4 times daily.

Chlordiazepoxide is metabolized or broken down by a group of enzymes in the liver known as the cytochrome P450 3A4 enzymes. Drugs which inhibit these enzymes reduce the metabolism of chlordiazepoxide and have the potential for causing side effects.

Examples of CYP3A4 inhibitors are:

• amiodarone (Cordarone)
• Anti-retroviral protease inhibitors (some types of anti-HIV medications)
• fluconazole (Diflucan)
• itraconazole (Sporanox)
• ketoconazole (Nizoral)
• voriconazole (Vfend)
• miconazole (Monistat)
• cimetidine (Tagamet)
• clarithromycin (Biaxin)

Additionally, inducers of the CYP 3A4 enzymes may increase the activity of these enzymes and cause blood levels of chlordiazepoxide to decrease.

Examples of CYP 3A4 inducers are:

• carbamazepine (Tegretol)
• rifampin (Rimactane)
• phenytoin (Dilantin)
• St. John's Wort

Chlordiazepoxide has depressant effects on the central nervous system. Medications which have similar activity may increase the risk for drowsiness, respiratory depression, and other CNS depressant effects. Therefore, co-administration with alcohol, kava-kava, other benzodiazepines, and opiates should generally be avoided.