Amitriptyline/chlordiazepoxide Disease Interactions

There are 20 disease interactions with amitriptyline/chlordiazepoxide:

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication, Alcoholism

The use of benzodiazepines is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Closed-Angle Glaucoma

Severe Potential Hazard, Low plausibility

Applies to: Glaucoma/Intraocular Hypertension

The manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, Drug Abuse/Dependence

Benzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage-tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Renal/Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Benzodiazepines are metabolized by the liver, and the metabolites are excreted in the urine. Chlordiazepoxide, clorazepate, diazepam, flurazepam and quazepam undergo oxidative N-dealkylation to active metabolites that are substantially longer-acting than the parent compound. These metabolites then undergo further biotransformation to pharmacologically inactive products before excretion by the kidney. Therapy with benzodiazepines should be administered cautiously at lower initial dosages in patients with impaired renal and/or hepatic function. Agents that are converted to weakly active, short-acting, or inactive metabolites may be preferable in hepatic impairment. Lorazepam, oxazepam and temazepam are conjugated to inactive metabolites, while alprazolam, estazolam and triazolam undergo hydroxylation to weakly active or inactive metabolites.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Pulmonary Impairment, Sleep Apnea, Asphyxia, Respiratory Arrest

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Seizures

Severe Potential Hazard, High plausibility

Applies to: Seizures

Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.

Benzodiazepines (Iv/Im) (Includes Amitriptyline/chlordiazepoxide) ↔ Prolonged Hypotension

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Shock

Benzodiazepines should not be administered by injection to patients in shock or coma. The hypnotic and hypotensive effects of these agents may be prolonged and intensified in such patients.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Anticholinergic Effects

Severe Potential Hazard, High plausibility

Applies to: Urinary Retention, Glaucoma/Intraocular Hypertension, Gastrointestinal Obstruction

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. Therapy with TCAs should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. In patients with angle-closure glaucoma, even average doses can precipitate an attack. Glaucoma should be treated and under control prior to initiation of therapy with TCAs, and intraocular pressure monitored during therapy.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: Cardiovascular Disease, Hyperthyroidism, Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Dehydration

Tricyclic and tetracyclic antidepressants (TCAs) may cause orthostatic hypotension, reflex tachycardia, syncope, and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Imipramine appears to have the greatest propensity to induce these effects, while secondary amines such as nortriptyline may do so less frequently. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, collapse and sudden death have occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include tachycardia, arrhythmias, heart block, hypertension, thrombosis, thrombophlebitis, myocardial infarction, strokes, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation. Therapy with TCAs should be avoided during the acute recovery phase following myocardial infarction, and should be administered only with extreme caution in patients with hyperthyroidism, a history of cardiovascular or cerebrovascular disease, or a predisposition to hypotension. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. Many of the newer antidepressants, including bupropion and the selective serotonin reuptake inhibitors (SSRIs), are considerably less or minimally cardiotoxic and may be appropriate alternatives.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Pheochromocytoma

Severe Potential Hazard, Moderate plausibility

Applies to: Pheochromocytoma

Tricyclic and tetracyclic antidepressants (TCAs) may potentiate the effects of circulating catecholamines. Enhanced sympathetic activity can provoke hypertensive crises in patients with pheochromocytoma or other tumors of the adrenal medulla, such as some neuroblastomas. Therapy with TCAs should be administered cautiously in patients with these tumors.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Seizure Disorders

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, CNS Disorder

Tricyclic antidepressants (TCAs) can lower the seizure threshold and trigger seizures in a dose-dependent manner. The risk appears to be greater with amoxapine and the tertiary amines (amitriptyline, doxepin, imipramine, trimipramine) than with the secondary amines (desipramine, nortriptyline, protriptyline). An incidence of up to 0.6% has been reported in patients treated with imipramine dosages > 200 mg/day. However, the incidence is generally much lower when smaller doses are used in patients without a predisposition to seizures. Therapy with TCAs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Depression

Moderate Potential Hazard, High plausibility

Applies to: Depression

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or suicidal tendencies. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Obesity

Moderate Potential Hazard, Moderate plausibility

Applies to: Obesity

The plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.

Benzodiazepines (Includes Amitriptyline/chlordiazepoxide) ↔ Paradoxical Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis, Hyperkinetic Syndrome of Childhood

Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.

Chlordiazepoxide (Includes Amitriptyline/chlordiazepoxide) ↔ Porphyria

Moderate Potential Hazard, Moderate plausibility

Applies to: Porphyria

There have been isolated reports associating the use of chlordiazepoxide with exacerbation of porphyria. Therapy with chlordiazepoxide should be administered cautiously in patients with porphyria.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Bone Marrow Suppression

Moderate Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

The use of tricyclic and tetracyclic antidepressants (TCAs) has rarely been associated with bone marrow suppression. Leukopenia, agranulocytosis, thrombocytopenia, anemia, eosinophilia, purpura, and pancytopenia have been reported with some TCAs. Patients with preexisting bone marrow suppression or blood dyscrasias receiving TCAs should be monitored closely during therapy for further decreases in blood counts.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Both elevation and lowering of blood sugar levels have been reported with the use of some tricyclic antidepressants (TCAs). Rarely, these effects have also occurred with maprotiline, a tetracyclic antidepressant. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents, particularly during dosage escalation or whenever dosage has been altered.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Renal/Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Tricyclic and tetracyclic antidepressants (TCAs) are known to undergo metabolism in the liver. Some of the metabolites, such as those of imipramine, clomipramine and desipramine, may be pharmacologically active. Many of the metabolites are also excreted by the kidney. There are very limited data concerning the use of TCAs in patients with renal and/or liver disease. Therapy with TCAs should be administered cautiously in patients with significantly impaired renal or hepatic function. Dosage adjustments may be necessary.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Schizophrenia/Bipolar Disorder

Moderate Potential Hazard, Moderate plausibility

Applies to: Schizophrenia, Bipolar Disorder, Mania

Tricyclic antidepressants (TCAs) may aggravate symptoms of psychosis in schizophrenic patients, particularly those with paranoid symptomatology. Depressed patients, usually those with bipolar disorder, may experience a switch from depression to mania or hypomania. These occurrences have also been reported rarely with the tetracyclic antidepressant, maprotiline. Therapy with these agents should be administered cautiously in patients with schizophrenia, bipolar disorder, or a history of mania.

Tcas (Includes Amitriptyline/chlordiazepoxide) ↔ Tardive Dyskinesia

Moderate Potential Hazard, Moderate plausibility

Applies to: Tardive Dyskinesia

Tricyclic and tetracyclic antidepressants (TCAs) have anticholinergic activity, to which elderly patients are particularly sensitive. Tertiary amines such as amitriptyline and trimipramine tend to exhibit greater anticholinergic effects than other agents in the class. As with other drugs that possess anticholinergic activity, TCAs may aggravate tardive dyskinesia or induce previously suppressed symptoms. Patients with tardive dyskinesia requiring therapy with TCAs should be monitored for exacerbation of the condition.

You should also know about...

amitriptyline/chlordiazepoxide drug Interactions

There are 1082 drug interactions with amitriptyline/chlordiazepoxide

amitriptyline/chlordiazepoxide alcohol/food Interactions

There are 2 alcohol/food interactions with amitriptyline/chlordiazepoxide

See also...

• Amitriptyline/chlordiazepoxide Side Effects
• Amitriptyline/chlordiazepoxide Consumer Information

• Drug Interactions Checker

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