Chlordiazepoxide and Amitriptyline (Systemic)

Brand Names : Limbitrol, Limbitrol DS

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For chlordiazepoxide and amitriptyline combination, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to chlordiazepoxide (e.g., Librium) or other benzodiazepines (such as alprazolam [e.g., Xanax], bromazepam [e.g., Lectopam], clonazepam [e.g., Klonopin], clorazepate [e.g., Tranxene], diazepam [e.g., Valium], estazolam [e.g., ProSom], flurazepam [e.g., Dalmane], halazepam [e.g., Paxipam], ketazolam [e.g., Loftran], lorazepam [e.g., Ativan], midazolam [e.g., Versed], nitrazepam [e.g., Mogadon], oxazepam [e.g., Serax], prazepam [e.g., Centrax], quazepam [e.g., Doral], temazepam [e.g., Restoril], triazolam [e.g., Halcion]) or to amitriptyline (e.g., Elavil) or other tricyclic antidepressants (such as amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]).

Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy -

• Chlordiazepoxide : Chlordiazepoxide has been reported to increase the chance of birth defects when used during the first 3 months of pregnancy.
  In addition, overuse of chlordiazepoxide during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects in the baby after birth.
  Use of chlordiazepoxide during pregnancy, especially during the last weeks, may cause drowsiness, slow heartbeat, shortness of breath, or troubled breathing in the newborn baby. Chlordiazepoxide given just before or during labor may cause weakness in the newborn baby.
• Amitriptyline : Studies with amitriptyline have not been done in pregnant women. However, studies in animals have shown amitriptyline to cause birth defects when used in doses many times the human dose. Also, there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants (such as amitriptyline) immediately before delivery.

Breast-feeding - Chlordiazepoxide may pass into the breast milk and cause drowsiness, slow heartbeat, shortness of breath, or troubled breathing in babies of mothers taking this medicine. Although amitriptyline has also been found in breast milk, it has not been reported to cause problems in nursing babies.

Children - Children may be especially sensitive to the effects of chlordiazepoxide and amitriptyline combination. This may increase the chance of side effects during treatment.

Older adults - Elderly people are especially sensitive to the effects of chlordiazepoxide and amitriptyline combination. This may increase the chance of side effects during treatment.

Other medicines - Although certain medicines should not be used together at all, in other cases 2 different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking chlordiazepoxide and amitriptyline combination, it is especially important that your health care professional know if you are taking any of the following:

• Alcohol or
• Central nervous system (CNS) depressants (medicines that cause drowsiness) - Using these medicines with chlordiazepoxide and amitriptyline combination may increase the CNS depressant effects

• Amphetamines or
• Appetite suppressants (diet pills) or
• Medicine for asthma or other breathing problems or
• Medicine for colds, sinus problems, or hay fever or other allergies (including nose drops or sprays) - Using these medicines with chlordiazepoxide and amitriptyline combination may increase the risk of serious effects on your heart

• Antacids - Taking these medicines with chlordiazepoxide and amitriptyline combination may delay the combination medicine's effects

• Antihypertensives (high blood pressure medicine) - Taking these medicines with chlordiazepoxide and amitriptyline combination may increase the chance of low blood pressure (hypotension)

• Antithyroid agents (medicine for overactive thyroid) or
• Cimetidine (e.g., Tagamet) - Taking these medicines with chlordiazepoxide and amitriptyline combination may increase the chance of serious side effects

• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) - Taking chlordiazepoxide and amitriptyline combination while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may cause sudden very high body temperature, extremely high blood pressure, and severe convulsions; however, sometimes certain of these medicines may be used with this combination medicine under close supervision by your doctor

Other medical problems - The presence of other medical problems may affect the use of chlordiazepoxide and amitriptyline combination. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse (or history of) or
• Drug abuse or dependence (or history of) - Dependence on this medicine may develop

• Bipolar disorder (manic-depressive illness) or
• Blood problems or
• Difficulty in urinating or
• Emphysema, asthma, bronchitis, or other chronic lung disease or
• Enlarged prostate or
• Glaucoma or increased eye pressure or
• Heart disease or
• Mental illness (severe) or
• Myasthenia gravis or
• Porphyria - Chlordiazepoxide and amitriptyline combination may make the condition worse

• Epilepsy or history of seizures - The risk of seizures may be increased

• Hyperactivity - Chlordiazepoxide and amitriptyline combination may cause unexpected effects

• Kidney disease or
• Liver disease - Higher blood levels of chlordiazepoxide and amitriptyline may occur, increasing the chance of side effects

• Overactive thyroid or
• Stomach or intestinal problems - Use of this combination medicine may result in more serious problems