Usage
This combination is not typically prescribed. While chlordiazepoxide + clidinium is used to treat gastrointestinal disorders, milk of magnesia is generally used separately as a laxative or antacid. Combining all three isn’t a standard practice, and the benefits and risks haven’t been rigorously studied. It’s crucial for doctors to carefully assess the individual patient’s needs and consider potential drug interactions before considering such a combination. This information pertains to the combination of chlordiazepoxide and clidinium.
Chlordiazepoxide + clidinium is prescribed for the adjunctive treatment of gastrointestinal disorders such as:
- Irritable bowel syndrome (IBS)
- Peptic ulcers
- Enterocolitis
Pharmacological Classification:
- Chlordiazepoxide: Benzodiazepine (Anxiolytic, Sedative, Hypnotic)
- Clidinium: Anticholinergic/Antispasmodic
Mechanism of Action: This combination works through two distinct mechanisms:
- Chlordiazepoxide enhances the effect of GABA, a neurotransmitter that reduces the activity of nerve cells in the brain, leading to a calming effect.
- Clidinium blocks the action of acetylcholine, a neurotransmitter that stimulates muscle contractions in the gut. This reduces gut motility and spasms.
Alternate Names
- Chlordiazepoxide + Clidinium: Librax (brand name)
How It Works
Pharmacodynamics:
- Chlordiazepoxide: Produces anxiolytic, sedative, hypnotic, muscle relaxant, and anticonvulsant effects.
- Clidinium: Reduces gastrointestinal motility, spasms, and secretions.
Pharmacokinetics:
- Chlordiazepoxide: Well-absorbed orally, metabolized in the liver, and excreted primarily in urine.
- Clidinium: Limited oral absorption, metabolized in the liver.
- Milk of magnesia is minimally absorbed systematically; acts locally in the gut and is then excreted.
Mode of Action:
- Chlordiazepoxide binds to benzodiazepine receptors, potentiating the inhibitory effects of GABA.
- Clidinium competitively inhibits the action of acetylcholine at muscarinic receptors.
- Milk Of Magnesia neutralizes gastric acid by reacting with the hydrochloric acid. It also retains water in the gut and acts as an osmotic laxative.
Elimination Pathways:
- Chlordiazepoxide: Primarily renal excretion.
- Clidinium: Hepatic metabolism and renal excretion.
- Milk Of Magnesia: Primarily faecal route.
Dosage
The following applies to chlordiazepoxide + clidinium only.
Standard Dosage
Adults:
- 1 or 2 capsules 3 or 4 times daily, before meals and at bedtime.
Children:
Not recommended for use in children due to lack of safety and efficacy data.
Special Cases:
- Elderly Patients: Start with the lowest effective dose (no more than 2 capsules/day initially) and increase gradually as needed. Avoid prolonged use.
- Patients with Renal Impairment: Dosage adjustment may be required.
- Patients with Hepatic Dysfunction: Dosage adjustment may be required.
- Patients with Comorbid Conditions: Individualized dosage adjustments are necessary, especially in patients with cardiovascular, respiratory, or hepatic diseases.
Clinical Use Cases
Specific dosages for these scenarios are not standardized and should be determined on a case-by-case basis. The use of chlordiazepoxide + clidinium in these settings is not common.
Dosage Adjustments
Adjustments should be based on age, renal or hepatic function, and other medical conditions.
Side Effects
The following refers to chlordiazepoxide + clidinium + milk of magnesia.
Common Side Effects
- Dry mouth, blurred vision, constipation, nausea, bloating, urinary retention, drowsiness, dizziness, rash, swelling, irregular menses, changes in libido, weakness, tiredness, confusion, impaired coordination. Milk of magnesia may cause loose motions and diarrhea.
Rare but Serious Side Effects
- Decreased sweating, dry/hot/flushed skin, fast/irregular heartbeat, loss of coordination, slurred speech, fainting, uncontrolled muscle movements, mental/mood changes (confusion, agitation, unusual excitement, depression), difficulty urinating, decreased sexual ability, signs of infection, signs of liver problems, slow or shallow breathing.
Long-Term Effects
Dependence, tolerance, and withdrawal symptoms upon discontinuation.
Adverse Drug Reactions (ADR)
Any severe side effects, allergic reactions, paradoxical reactions, anterograde amnesia, or withdrawal symptoms require immediate intervention.
Contraindications
- Hypersensitivity to any component.
- Glaucoma (angle-closure).
- Prostatic hypertrophy.
- Bladder neck obstruction.
- Severe respiratory depression.
- Untreated myasthenia gravis.
Drug Interactions
Many drugs interact with this combination; consult a comprehensive drug interaction database before co-prescribing. Some notable interactions include:
- Alcohol
- CNS depressants (e.g., opioids, antihistamines)
- Anticholinergics (e.g., atropine)
- Antacids (may interfere with absorption of clidinium)
Pregnancy and Breastfeeding
Chlordiazepoxide + clidinium is contraindicated in pregnancy and breastfeeding due to potential risks to the fetus and infant.
Drug Profile Summary (Chlordiazepoxide + Clidinium)
Popular Combinations (Chlordiazepoxide + Clidinium)
Not applicable. Combinations containing this duo are rare.
Precautions (Chlordiazepoxide + Clidinium + Milk of Magnesia)
- Pre-existing medical conditions: Screen for glaucoma, prostatic hypertrophy, bladder neck obstruction, myasthenia gravis, respiratory or liver impairment.
- Pregnant/Breastfeeding Women: Contraindicated.
- Children & Elderly: Use with caution in the elderly; contraindicated in children.
FAQs
Q1: What is the recommended dosage for Chlordiazepoxide + Clidinium?
A: For adults, the usual dose is 1 or 2 capsules 3-4 times daily, before meals and at bedtime. Elderly patients should start with a lower dose. It is not recommended for children. This combination is not typically used with milk of magnesia.
Q2: What are the common side effects?
A: Common side effects include dry mouth, blurred vision, constipation, drowsiness, dizziness, and urinary retention. Milk of magnesia may lead to diarrhea or loose motion.
Q3: What are the contraindications?
A: Contraindications include glaucoma, prostatic hypertrophy, bladder neck obstruction, severe respiratory depression, hypersensitivity, and myasthenia gravis.
Q4: Can this medication be used during pregnancy or breastfeeding?
A: No, it’s contraindicated.
Q5: How does chlordiazepoxide work?
A: It enhances the effect of GABA, a neurotransmitter that inhibits nerve cell activity in the brain.
Q6: How does clidinium work?
A: It blocks acetylcholine’s action at muscarinic receptors, reducing gut motility and spasms.
Q7: What are the signs of an overdose?
A: Overdose can manifest as central nervous system depression, including drowsiness, confusion, and slowed breathing. Anticholinergic toxicity may also occur, presenting as dry mouth, blurred vision, and difficulty urinating.
Q8: What should patients be advised about lifestyle?
A: Avoid alcohol and other CNS depressants. Caution patients against activities requiring alertness (e.g., driving) until the drug’s effects are known.
A: Chlordiazepoxide is primarily metabolized in the liver and excreted in urine. Clidinium is also metabolized in the liver. Milk Of Magnesia is not absorbed systemically.
