$Unique_ID{BRK01877}
$Pretitle{}
$Title{CHLORDIAZEPOXIDE AND AMITRIPTYLINE COMBINATION}
$Subject{Limbitrol (Roche)}
$Volume{}
$Log{}

Copyright (C) 1991 Publications International, Ltd.


CHLORDIAZEPOXIDE AND AMITRIPTYLINE COMBINATION
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BRAND NAME (Manufacturer):
     Limbitrol (Roche)
TYPE OF DRUG:
     Benzodiazepine antianxiety and antidepressant
INGREDIENT:
     Schlordiazepoxide 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 should be taken exactly as your doctor prescribes.  In
order to avoid stomach upset, you can take it 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 by sucking 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 carbamazepine,
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, so 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.

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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.
