ChlordiazepoxideChlordiazepoxide Hydrochloride

About Chlordiazepoxide

Chlordiazepoxide is a benzodiazepine, the class that includes diazepam and lorazepam. Its label covers anxiety disorders and the short-term relief of anxiety symptoms, apprehension and anxiety before surgery, and withdrawal symptoms of acute alcoholism. For mild to moderate anxiety adults usually take 5 or 10 mg three or four times a day, and for severe anxiety 20 or 25 mg three or four times a day. Older or debilitated people are kept to the smallest effective amount, starting at 10 mg a day or less; children 6 and older usually take 5 mg two to four times a day, and it is not recommended under 6. In acute alcohol withdrawal, 50 to 100 mg is repeated as needed until agitation is controlled, up to 300 mg a day, then reduced.

Its boxed warning covers three risks: with opioids it can cause profound sedation, slowed breathing, coma and death; it can lead to abuse, misuse and addiction, which can end in overdose or death; and continued use causes physical dependence, so stopping suddenly or cutting the dose quickly can bring on life-threatening withdrawal, and it is tapered. Withdrawal symptoms sometimes last from weeks to more than 12 months. Drowsiness, unsteadiness and confusion are the most common side effects, and some people, mainly psychiatric patients and hyperactive, aggressive children, react with excitement or rage instead. The only contraindication is an allergy to the drug.

As a Schedule IV drug, a prescription can carry up to five refills within six months of the date written. The label notes that use beyond 4 months has not been assessed in systematic studies, so the prescriber should reassess it periodically, and with long treatment blood counts and liver tests are advised. Recent labels say use late in pregnancy can cause sedation or withdrawal symptoms in the newborn and that breastfeeding is not recommended during treatment, and MedlinePlus says older adults usually should not take it. The combinations with amitriptyline (Limbitrol, now discontinued) and with clidinium (Librax) are separate products with their own labels.

Taking Chlordiazepoxide

How to take it

As prescribed, usually one to four times a day, with or without food. Do not drive or do anything that needs alertness until you know how it affects you, and do not stop it or lower the dose on your own; the prescriber tapers it.

If you miss a dose

If you take several doses a day and miss one, MedlinePlus says to skip it and continue your regular schedule. Do not take a double dose.

Storage

In the original container, tightly closed, at room temperature and protected from light, out of reach of children and others. Do not flush it; use a take-back program.

Interactions to know about

Opioids can cause deep sedation, slowed breathing, coma and death with it, and alcohol and other sedatives add to its effects; MedlinePlus says not to drink alcohol during treatment. The label urges care when combining it with MAO inhibitors or phenothiazines, and rare changes in clotting have been reported with oral anticoagulants.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Chlordiazepoxide differs from pharmacy to pharmacy

Chlordiazepoxide is an old generic made by only a few companies, so a pharmacy that does not keep it on hand may need to order it. Doses are often taken three or four times a day, so the quantity per fill and the mix of capsule strengths shape the quote.

Refill information for a Schedule IV prescription can be transferred between pharmacies only once, unless they share a real-time database, so it is worth choosing the pharmacy before the first fill.

Ways to pay less for Chlordiazepoxide without insurance

• Ask whether chlordiazepoxide is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If your dose is made of several smaller capsules, ask the prescriber whether one larger capsule could give the same dose.
• A Schedule IV prescription can carry up to five refills within six months; ask the prescriber whether refills suit your treatment.
• If it is quoted high, ask the prescriber whether another benzodiazepine or a different anxiety treatment would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Chlordiazepoxide

1. 1.How long am I meant to take it, and how would it be tapered?
2. 2.Is it safe with my pain, sleep or other medicines?
3. 3.How many refills does my prescription carry, and can they be transferred?
4. 4.Which side effects should I report, especially in an older relative?

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