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Librax Disease Interactions

There are 21 disease interactions with Librax (chlordiazepoxide / clidinium).

Major

Anticholinergics (applies to Librax) arrhythmias

Major Potential Hazard, High plausibility.

Patients with tachycardia should be supervised closely during treatment with anticholinergic agents. Tachycardia is produced by blocking normal vagal inhibition of the SA node. Paradoxically, bradycardia may occur due to central vagal stimulation which may occur prior to peripheral cholinergic blockade.

References

  1. Blumensohn R, Razoni G, Shalev A, Munitz H "Bradycardia due to trihexyphenidyl hydrochloride." Drug Intell Clin Pharm 20 (1986): 786-7
  2. Voinov H, Elefante V, Mujica R "Sinus bradycardia related to the use of benztropine mesylate." Am J Psychiatry 149 (1992): 711
  3. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
Major

Anticholinergics (applies to Librax) autonomic neuropathy

Major Potential Hazard, High plausibility.

Agents with anticholinergic activity can exacerbate many of the manifestations of autonomic neuropathy, including tachycardia, anhidrosis, bladder atony, obstipation, dry mouth and eyes, cycloplegia and blurring of vision, and sexual impotence in males. Therapy with antimuscarinic agents and higher dosages of antispasmodic agents (e.g., dicyclomine or oxybutynin) should be administered cautiously in patients with autonomic neuropathy.

References

  1. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
Major

Anticholinergics (applies to Librax) GI obstruction

Major Potential Hazard, High plausibility. Applicable conditions: Esophageal Obstruction, Gastrointestinal Obstruction

Anticholinergics are contraindicated in patients with obstructive diseases such as achalasia, esophageal stricture or stenosis, pyloroduodenal stenosis, stenosing peptic ulcer, pyloric obstruction, and paralytic ileus. Anticholinergics may further suppress intestinal motility with resultant precipitation or aggravation of toxic megacolon.

References

  1. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  2. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  3. Blamoutier J "Comparative trial of two antihistamines, mequitazine and brompheniramine." Curr Med Res Opin 5 (1978): 366-70
  4. "Azatadine (optimine)--a new antihistamine." Med Lett Drugs Ther 19 (1977): 77-9
  5. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  6. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  7. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  8. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  9. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  11. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  12. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  13. Mevorach D "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother 26 (1992): 564
  14. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  15. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  16. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
View all 16 references
Major

Anticholinergics (applies to Librax) glaucoma

Major Potential Hazard, High plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

Anticholinergic agents are contraindicated in patients with primary glaucoma, a tendency toward glaucoma (narrow anterior chamber angle), or adhesions (synechiae) between the iris and lens, as well as for the elderly and others in whom undiagnosed glaucoma or excessive pressure in the eye may be present. Because anticholinergics cause mydriasis, they may exacerbate these conditions.

References

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  4. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  5. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  6. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  7. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  8. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  9. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  10. O'Connor PS, Mumma JV "Atropine toxicity." Am J Ophthalmol 99 (1985): 613-4
  11. Clearkin LG "Angle closure glaucoma precipitated by atropine." Arch Intern Med 152 (1992): 880
  12. Berdy GJ, Berdy SS, Odin LS, Hirst LW "Angle closure glaucoma precipitated by aerosolized atropine." Arch Intern Med 151 (1991): 1658-60
  13. Pecora JL "Malignant glaucoma worsened by miotics in a postoperative angle- closure glaucoma patient." Ann Ophthalmol 11 (1979): 1412-4
  14. Holland MG "Autonomic drugs in ophthalmology: some problems and promises. Section II: Anticholinergic drugs." Ann Ophthalmol 6 (1974): 661-4
  15. Kanto J "New aspects in the use of atropine." Int J Clin Pharmacol Ther Toxicol 21 (1983): 92-4
  16. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  17. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  18. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34
  19. "Product Information. Cogentin (benztropine)." Merck & Company Inc (2001):
  20. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  21. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  22. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  23. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
View all 23 references
Major

Anticholinergics (applies to Librax) obstructive uropathy

Major Potential Hazard, High plausibility. Applicable conditions: Urinary Retention

In general, the use of anticholinergic agents is contraindicated in patients with urinary retention and bladder neck obstruction caused by prostatic hypertrophy. Dysuria may occur and may require catheterization. Also, anticholinergic drugs may aggravate partial obstructive uropathy. Caution is advised even when using agents with mild to moderate anticholinergic activity, particularly in elderly patients.

References

  1. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  2. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  3. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  6. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  7. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  8. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  10. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  11. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  12. Shutt LE, Bowes JB "Atropine and hyoscine." Anaesthesia 34 (1979): 476-90
  13. O'Kelly SW, Spargo PM "Postoperative urinary retention in men." BMJ 302 (1991): 1403-4
  14. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  15. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  16. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  17. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  18. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  19. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  20. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
View all 20 references
Major

Anticholinergics (applies to Librax) tardive dyskinesia

Major Potential Hazard, High plausibility.

Anticholinergic agents and agents with secondary anticholinergic activity may aggravate tardive dyskinesia or induce previously suppressed symptoms. Therapy with these agents should be avoided, if possible, or administered cautiously in patients with preexisting tardive dyskinesia, particularly in the elderly. If tardive dyskinesia symptoms develop or worsen during treatment with an anticholinergic agent, prompt withdrawal of therapy will provide better chances of improving the condition.

References

  1. Brait KA, Zagerman AJ "Dyskinesias after antihistamine use ." N Engl J Med 296 (1977): 111
  2. Jones B, Lal S "Tardive dyskinesia uncovered after ingestion of Sominex, an over-the- counter drug." Can J Psychiatry 30 (1985): 370-1
  3. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  4. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  5. Burnett GB, Prange AJ Jr, Wilson IC, Jolliff LA, Creese IC, Synder SH "Adverse effects of anticholinergic antiparkinsonian drugs in tardive dyskinesia. An investigation of mechanism." Neuropsychobiology 6 (1980): 109-20
  6. Kiloh LG, Smith JS, Williams SE "Antiparkinson drugs as causal agents in tardive dykinesia." Med J Aust 2 (1973): 591-3
  7. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
View all 7 references
Major

Antiperistaltic agents (applies to Librax) infectious diarrhea

Major Potential Hazard, High plausibility. Applicable conditions: Infectious Diarrhea/Enterocolitis/Gastroenteritis

The use of drugs with antiperistaltic activity (primarily antidiarrheal and antimuscarinic agents, but also antispasmodic agents such as dicyclomine or oxybutynin at high dosages) is contraindicated in patients with diarrhea due to pseudomembranous enterocolitis or enterotoxin-producing bacteria. These drugs may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella and Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. In general, because antiperistaltic agents decrease gastrointestinal motility, they may delay the excretion of infective gastroenteric organisms or toxins and should be used cautiously in patients with any infectious diarrhea, particularly if accompanied by high fever or pus or blood in the stool. Some cough and cold and other combination products may occasionally include antimuscarinic agents for their drying effects and may, therefore, require careful selection when necessary.

References

  1. Brown JW "Toxic megacolon associated with loperamide therapy." JAMA 241 (1979): 501-2
  2. Walley T, Milson D "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J 66 (1990): 582
  3. "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals (2001):
  4. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4
  5. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
  6. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
View all 6 references
Major

Benzodiazepines (applies to Librax) acute alcohol intoxication

Major Potential Hazard, High plausibility.

The use of benzodiazepines with alcohol is not recommended. Patients with acute alcohol intoxication exhibit depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol, and severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  14. "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
View all 14 references
Major

Benzodiazepines (applies to Librax) closed-angle glaucoma

Major Potential Hazard, Low plausibility. Applicable conditions: 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.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  14. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann (2001):
View all 14 references
Major

Benzodiazepines (applies to Librax) drug dependence

Major Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
  14. "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
View all 14 references
Major

Benzodiazepines (applies to Librax) renal/liver disease

Major Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. Sellers EM, Greenblatt DJ, Giles HG, et al. "Chlordiazepoxide and oxazepam disposition in cirrhosis." Clin Pharmacol Ther 26 (1979): 240-6
  2. Hicks R, Dysken MW, Davis JM, et al. "The pharmacokinetics of psychotropic medication in the elderly: a review." J Clin Psychiatry 42 (1981): 374-85
  3. Murray TG, Chiang ST, Koepke HH, Walker BR "Renal disease, age, and oxazepam kinetics." Clin Pharmacol Ther 30 (1981): 805-9
  4. Hoyumpa AM "Disposition and elimination of minor tranquilizers in the aged and in patients with liver disease." South Med J 71 (1978): 23-8
  5. Kraus JW, Desmond PV, Marshall JP, Johnson RF, Schenker S, Wilkinson GR "Effects of age and liver disease on disposition of lorazepam." Clin Pharmacol Ther 24 (1978): 411-9
  6. Verbeeck RK, Tjandramaga TB, de Schepper PJ, Verberckmoes R "Impaired elimination of lorazepam following subchronic administration in two patients with renal failure." Br J Clin Pharmacol 12 (1981): 749-50
  7. Greenblatt DJ "Clinical pharmacokinetics of oxazepam and lorazepam." Clin Pharmacokinet 6 (1981): 89-105
  8. Morrison G, Chiang ST, Koepke HH, Walker BR "Effect of renal impairment and hemodialysis on lorazepam kinetics." Clin Pharmacol Ther 35 (1984): 646-52
  9. Klotz U, Avant GR, Hoyumpa A, Schenker S, Wikinson GR "The effects of age and liver disease on the disposition and elimination of diazepam in adult man." J Clin Invest 55 (1975): 347-59
  10. Cutler RE, Blair AD "Pharmacokinetics of diazepam in normal and uremic humans." Clin Pharmacol Ther 25 (1979): 219-20
  11. Ochs HR, Greenblatt DJ, Kaschell HJ, Klehr U, Divoll M, Abernathy DR "Diazepam kinetics in patients with renal insufficiency or hyperthyroidism." Br J Clin Pharmacol 12 (1981): 829-32
  12. Schmith VD, Piraino B, Smith RB, Kroboth PD "Alprazolam in end-stage renal disease: I. Pharmacokinetics." J Clin Pharmacol 31 (1991): 571-9
  13. Dehlin O, Kullingsjo H, Liden A, Agrell B, Moser G, Olsen I "Pharmacokinetics of alprazolam in geriatric patients with neurotic depression." Pharmacol Toxicol 68 (1991): 121-4
  14. Sellers EM, Greenblatt DJ, Giles HG, et al. "Chlordiazepoxide and oxazepam disposition in cirrhosis." Clin Pharmacol Ther 26 (1979): 240-6
  15. Morgan DD, Robinson JD, Mendenhall CL "Clinical pharmacokinetics of chlordiazepoxide in patients with alcoholic hepatitis." Eur J Clin Pharmacol 19 (1981): 279-85
  16. Tedesco FJ, Mills LR "Diazepam (valium) hepatitis." Dig Dis Sci 27 (1982): 470-2
  17. de Silva JAF, Strojny N "Determination of flurazepam and its major biotransformation products in blood and urine by spectrophotofluorometry and spectrophotometry." J Pharm Sci 60 (1971): 1303-14
  18. Kaplan SA, de Silva JAF, Jack ML, et al. "Blood level profile in man following chronic oral administration of flurazepam hydrochloride." J Pharm Sci 62 (1973): 1932-5
  19. Greenblatt DJ, Divoll M, Harmatz JJ "Kinetics and clinical effects of flurazepam in young and elderly noninsomniacs." Clin Pharmacol Ther 30 (1981): 475-86
  20. Ghabrial H, Desmond PV, Watson KJ, et al. "The effects of age and chronic liver disease on the elimination of temazepam." Eur J Clin Pharmacol 30 (1986): 93-7
  21. Busch U, Molzahn M, Bozler G, Koss FW "Pharmacokinetics of oxazepam following multiple administration in volunteers and patients with chronic renal disease." Arzneimittelforschung 31 (1981): 1507-11
  22. Juhl RP, Van Thiel DH, Dittert LW, Smith RB "Alprazolam pharmacokinetics in alcoholic liver disease." J Clin Pharmacol 24 (1984): 113-9
  23. Johnson J, Padilla BG, Carter J, Holt JH, Ozawa T "Adverse effects of flurazepam in a hemodialysis patient." J Am Assoc Nephrol Nurses Tech 4 (1977): 93-5
  24. Kroboth PD, Smith RB, Rault R, Silver MR, Sorkin MI, Puschett JB, Juhl RP "Effects of end-stage renal disease and aluminum hydroxide on temazepam kinetics." Clin Pharmacol Ther 37 (1985): 453-9
  25. Wilensky AJ, Levy RH, Troupin AS, Moretti-Ojemann L "Clorazepate kinetics in treated epileptics." Clin Pharmacol Ther 24 (1978): 22-30
  26. Greenblatt DJ, Divoll MK, Soong MH, Boxenbaum HG, Harmatz JS, Shader RI "Desmethyldiazepam pharmacokinetics: studies following intravenous and oral desmethyldiazepam, oral clorazepate, and intravenous diazepam." J Clin Pharmacol 28 (1988): 853-9
  27. Ochs HR, Rauh HW, Greenblatt DJ, Kaschell HJ "Clorazepate dipotassium and diazepam in renal insufficiency: serum concentrations and protein binding of diazepam and desmethyldiazepam." Nephron 37 (1984): 100-4
  28. Roberts RK, Wilkinson GR, Branch RA, Schenker S "Effect of age and parenchymal liver disease on the disposition and elimination of chlordiazepoxide (librium)." Gastroenterology 75 (1978): 479-85
  29. Kroboth PD, Smith RB, Silver MR, Rault R, Sorkin MI, Puschett JB, Juhl RP "Effects of end stage renal disease and aluminium hydroxide on triazolam pharmacokinetics." Br J Clin Pharmacol 19 (1985): 839-42
  30. Kroboth PD, Smith RB, Van Thiel DH, Juhl RP "Nighttime dosing of triazolam in patients with liver disease and normal subjects: kinetics and daytime effects." J Clin Pharmacol 27 (1987): 555-60
  31. Hilbert JM, Chung M, Radwanski E, Gural R, Symchowicz S, Zampaglione N "Quazepam kinetics in the elderly." Clin Pharmacol Ther 36 (1984): 566-9
  32. Chung M, Hilbert JM, Gural RP, Radwanski E, Symchowicz S, Zampaglione N "Multiple-dose quazepam kinetics." Clin Pharmacol Ther 35 (1984): 520-4
  33. Gustavson LE, Carrigan PJ "The clinical pharmacokinetics of single doses of estazolam." Am J Med 88 (1990): s2-5
  34. Allen MD, Greenblatt DJ, Arnold JD "Single- and multiple-dose kinetics of estazolam, a triazolo benzodiazepine." Psychopharmacology (Berl) 66 (1979): 267-74
  35. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  36. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  37. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  38. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  39. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  40. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  41. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  42. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  43. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  44. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  45. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  46. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  47. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
View all 47 references
Major

Benzodiazepines (applies to Librax) respiratory depression

Major Potential Hazard, High plausibility. Applicable conditions: Pulmonary Impairment, 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.

References

  1. Iber FL, Livak A, Kruss DM "Apnea and cardiopulmonary arrest during and after endoscopy." J Clin Gastroenterol 14 (1992): 109-13
  2. Cohen S, Khan A "Respiratory distress with use of lorazepam in mania." J Clin Psychopharmacol 7 (1987): 199-200
  3. Donaldson D, Gibson G "System complications with intravenous diazepam." Oral Surg Oral Med Oral Patho 49 (1980): 126-30
  4. Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90
  5. Man GC, Hsu K, Sproule BJ "Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease." Chest 90 (1986): 832-6
  6. Mendelson WB, Weingartner H, Greenblatt DJ, Garnett D, Gillin JC "A clinical study of flurazepam." Sleep 5 (1982): 350-60
  7. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  8. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  9. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  10. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  12. Pierce MW, Shu VS, Groves LJ "Safety of estazolam. The United States clinical experience." Am J Med 88 (1990): s12-7
  13. Skatrud JB, Badr S, Begle RL, Juan D "Ventilatory response to single, high dose estazolam in healthy humans." J Clin Pharmacol 30 (1990): 543-8
  14. Sullivan RJ, Jr "Respiratory depression requiring ventilatory support following 0.5 mg of triazolam." J Am Geriatr Soc 37 (1989): 450-2
  15. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  16. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  17. Model DG, Berry DJ "Effects of chlordiazepoxide in respiratory failure due to chronic bronchitis." Lancet 2 (1974): 869-70
  18. Dixon D "Respiratory depression following midazolam." Anaesthesia 40 (1985): 922
  19. Yakel DL, Jr Whittaker SE, Elstad MR "Midazolam-induced angioedema and bronchoconstriction." Crit Care Med 20 (1992): 307-8
  20. Berggren L, Eriksson I, Mollenholt P, Sunzel M "Changes in respiratory pattern after repeated doses of diazepam and midazolam in healthy subjects." Acta Anaesthesiol Scand 31 (1987): 667-72
  21. Taylor JW, Simon KB "Possible intramuscular midazolam-associated cardiorespiratory arrest and death." DICP 24 (1990): 695-7
  22. Munoz HR, Dagnino JA, Rufs JA, Bugedo GJ "Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients." Reg Anesth 17 (1992): 139-42
  23. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  24. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  25. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  26. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  27. Murphy PJ, Erskine R, Langton JA "The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes." Anaesthesia 49 (1994): 105-10
  28. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  29. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  30. Berry RB, Kouchi K, Bower J, Prosise G, Light RW "Triazolam in patients with obstructive sleep apnea." Am J Respir Crit Care Med 151 (1995): 450-4
  31. "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
View all 31 references
Major

Benzodiazepines (applies to Librax) seizures

Major Potential Hazard, Moderate plausibility.

The use of benzodiazepines in patients with seizure disorders may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). Appropriate anticonvulsant medication might need to be initiated or the dosage increased. 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.

References

  1. Ananth J "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 592
  2. Wilbur R, Kulik AV "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 298-300
  3. Busto U, Sellers EM, Naranjo CA, et al. "Withdrawal reaction after long-term therapeutic use of benzodiazepines." N Engl J Med 315 (1986): 854-9
  4. Hersch EL, Billings RF "Acute confusional state with status petit mal as a withdrawal syndrome: and five year follow-up." Can J Psychiatry 33 (1988): 157-9
  5. Howe JG "Lorazepam withdrawal seizures." Br Med J 280 (1980): 1163-4
  6. Kales A, Bixler EO, Soldatos CR, Jacoby JA, Kales JD "Lorazepam: effects on sleep and withdrawal phenomena." Pharmacology 32 (1986): 121-30
  7. Robinson GM, Sellers EM "Diazepam withdrawal seizures." Can Med Assoc J 126 (1982): 944-5
  8. Browne JL, Hauge KJ "A review of alprazolam withdrawal." Drug Intell Clin Pharm 20 (1986): 837-41
  9. Ghadirian AM, Gauthier S, Wong T "Convulsions in patients abruptly withdrawn from clonazepam while receiving neuroleptic medication ." Am J Psychiatry 144 (1987): 686
  10. Hauser P, Devinsky O, De Bellis M, Theodore WH, Post RM "Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders." Arch Neurol 46 (1989): 696-9
  11. Specht U, Boenigk HE, Wolf P "Discontinuation of clonazepam after long-term treatment." Epilepsia 30 (1989): 458-63
  12. Alvarez N, Hartford E, Doubt C "Epileptic seizures induced by clonazepam." Clin Electroencephalogr 12 (1981): 57-65
  13. Berlin RM, Conell LJ "Withdrawal symptoms after long-term treatment with therapeutic doses of flurazepam: a case report." Am J Psychiatry 140 (1983): 488-90
  14. Bond WS, Schwartz M "Withdrawal reactions after long-term treatment with flurazepam." Clin Pharm 3 (1984): 316-8
  15. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  16. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  17. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  18. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  19. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  20. Tien AY, Gujavarty KS "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
  21. Patterson WM "Triazolam withdrawal." J Clin Psychiatry 49 (1988): 369
  22. Schneider LS, Syapin PJ, Pawluczyk S "Seizures following triazolam withdrawal despite benzodiazepine treatment." J Clin Psychiatry 48 (1987): 418-9
  23. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  24. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  25. Ryan GP, Boisse NR "Experimental induction of benzodiazepine tolerance and physical dependence." J Pharmacol Exp Ther 226 (1983): 100-7
  26. Petursson H, Lader MH "Benzodiazepine dependence." Br J Addict 76 (1981): 133-45
  27. Finley PR, Nolan PE, Jr "Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam." DICP 23 (1989): 151-2
  28. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  29. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  30. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  31. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  32. Roy-Byrne PP, Sullivan MD, Cowley DS, Ries RK "Adjunctive treatment of benzodiazepine discontinuation syndromes - a review." J Psychiatr Res 27 Suppl (1993): 143-53
  33. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  34. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  35. Frattola L, Garreau M, Piolti R, Bassi S, Albizzati MG, Borghi C, Morselli PL "Comparison of the efficacy, safety and withdrawal of alpidem and alprazolam in anxious patients." Br J Psychiatry 165 (1994): 94-100
View all 35 references
Major

Benzodiazepines (iv/im) (applies to Librax) prolonged hypotension

Major Potential Hazard, High plausibility. Applicable conditions: 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.

References

  1. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  2. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  4. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  5. "Product Information. Byfavo (remimazolam)." Acacia Pharma, Inc (2020):
View all 5 references
Moderate

Antimuscarinics (applies to Librax) psychoses

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis

Toxic psychosis manifested as confusion, disorientation, agitation, excitation, memory impairment, delusions and hallucinations may develop at toxic and therapeutic dosages of antimuscarinic agents. Therapy with these agents should be administered cautiously in patients with mental disorders receiving antimuscarinic agents for control of drug-induced extrapyramidal effects, especially at the beginning of therapy or during dosage adjustment. Psychiatric deterioration and psychotic flare-ups have also been reported following withdrawal of therapy. Symptoms include delusions, hallucinations, aggression or violent behavior, and suicidal tendencies. In high dosages, antimuscarinic agents may sometimes produce euphorigenic effects. For this reason, it can be a drug of abuse.

References

  1. Jellinek T, Gardos G, Cole JO "Adverse effects of antiparkinson drug withdrawal." Am J Psychiatry 138 (1981): 1567-71
  2. Goggin DA, Solomon GF "Trihexyphenidyl abuse for euphorigenic effect." Am J Psychiatry 136 (1979): 459-60
  3. Macvicar K "Abuse of antiparkinsonian drugs by psychiatric patients." Am J Psychiatry 134 (1977): 809-11
  4. Craig DH, Rosen P "Abuse of antiparkinsonian drugs." Ann Emerg Med 10 (1981): 98-100
  5. Pullen GP, Best NR, Maguire J "Anticholinergic drug abuse: a common problem?" Br Med J (Clin Res Ed) 289 (1984): 612-3
  6. Rubinstein JS "Abuse of antiparkinsonism drugs. Feigning of extrapyramidal symptoms to obtain trihexyphenidyl." JAMA 239 (1978): 2365-6
  7. McInnis M, Petursson H "Trihexyphenidyl dependence." Acta Psychiatr Scand 69 (1984): 538-42
  8. Mohan D, Mohandas E, Dube S "Trihexyphenidyl abuse." Br J Addict 76 (1981): 195-7
  9. Kaminer Y, Munitz H, Wijsenbeek H "Trihexyphenidyl (Artane) abuse: euphoriant and anxiolytic." Br J Psychiatry 140 (1982): 473-4
  10. Warnes H "Toxic psychosis due to antiparkinsonian drugs." Can Psychiatr Assoc J 12 (1967): 323-6
  11. Hidalgo HA, Mowers RM "Anticholinergic drug abuse." DICP 24 (1990): 40-1
  12. Wilcox JA "Psychoactive properties of benztropine and trihexyphenidyl." J Psychoactive Drugs 15 (1983): 319-21
  13. Laski E, Taleporos E "Anticholinergic psychosis in a bilingual: a case study." Am J Psychiatry 134 (1977): 1038-40
  14. Brower KJ "Smoking of prescription anticholinergic drugs." Am J Psychiatry 144 (1987): 383
  15. Baker LA, Cheng LY, Amara IB "The withdrawal of benztropine mesylate in chronic schizophrenic patients." Br J Psychiatry 143 (1983): 584-90
  16. Moreau A, Jones BD, Banno V "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry 31 (1986): 339-41
  17. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  18. Ananth JV, Jain RC "Benztropine psychosis." Can Psychiatr Assoc J 18 (1973): 409-14
  19. Woody GE, O'Brien CP "Anticholinergic toxic psychosis in drug abusers treated with benztropine." Compr Psychiatry 15 (1974): 439-42
  20. "Product Information. Cogentin (benztropine)." Merck & Company Inc (2001):
  21. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82
  22. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
View all 22 references
Moderate

Benzodiazepines (applies to Librax) depression

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. 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 other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Onfi (clobazam)." Lundbeck Inc (2011):
View all 13 references
Moderate

Benzodiazepines (applies to Librax) obesity

Moderate Potential Hazard, Moderate plausibility.

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.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  2. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  6. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  7. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  8. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  9. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  10. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  11. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  12. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  13. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
  14. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
View all 14 references
Moderate

Benzodiazepines (applies to Librax) paradoxical reactions

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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.

References

  1. French AP "Dangerously aggressive behavior as a side effect of alprazolam." Am J Psychiatry 146 (1989): 276
  2. Goodman WK, Charney DS "A case of alprazolam, but not lorazepam, inducing manic symptoms." J Clin Psychiatry 48 (1987): 117-8
  3. Edwards JG, Inman WH, Pearce GL, Rawson NS "Prescription-event monitoring of 10,895 patients treated with alprazolam." Br J Psychiatry 158 (1991): 387-92
  4. Wysowski DK, Barash D "Adverse behavioral reactions attributed to triazolam in the Food and Drug Administration's Spontaneous Reporting System." Arch Intern Med 151 (1991): 2003-8
  5. Bixler EO, Kales A, Brubaker BH, Kales JD "Adverse reactions to benzodiazepine hypnotics: spontaneous reporting system." Pharmacology 35 (1987): 286-300
  6. Cohen LS, Rosenbaum JF "Clonazepam: new uses and potential problems." J Clin Psychiatry 48 (1987): 50-6
  7. White MC, Silverman JJ, Harbison JW "Psychosis associated with clonazepam therapy for blepharospasm." J Nerv Ment Dis 170 (1982): 117-9
  8. Dorevitch A "Mania associated with clonazepam." DICP 25 (1991): 938-9
  9. Marchevsky S, Isaacs G, Nitzan I "Behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 10 (1988): 447
  10. Binder RL "Three case reports of behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 9 (1987): 151-3
  11. Koczerginski D, Kennedy SH, Swinson RP "Clonazepam and lithium--a toxic combination in the treatment of mania?" Int Clin Psychopharmacol 4 (1989): 195-9
  12. Fava M, Borofsky GF "Sexual disinhibition during treatment with a benzodiazepine: a case report." Int J Psychiatry Med 21 (1991): 99-104
  13. Cunningham TA "Letter: Adverse reaction to flurazepam." Can Med Assoc J 112 (1975): 805
  14. Pollack MH "Clonazepam: a review of open clinical trials." J Clin Psychiatry 48 (1987): 12-5
  15. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn (2002):
  16. "Product Information. Valium (diazepam)." Roche Laboratories (2002):
  17. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories (2002):
  18. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories (2001):
  19. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation (2001):
  20. Karch FE "Rage reaction associated with clorazepate dipotassium." Ann Intern Med 91 (1979): 61-2
  21. Weilburg JB, Sachs G, Falk WE "Triazolam-induced brief episodes of secondary mania in a depressed patient." J Clin Psychiatry 48 (1987): 492-3
  22. Rothschild AJ "Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature." J Clin Psychiatry 53 (1992): 69-79
  23. Schogt B, Conn D "Paranoid symptoms associated with triazolam." Can J Psychiatry 30 (1985): 462-3
  24. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn (2001):
  25. "Product Information. Dalmane (flurazepam)." Roche Laboratories (2001):
  26. Viscott DS "Chlordiazepoxide and hallucinations. Report of cases." Arch Gen Psychiatry 19 (1968): 370-6
  27. Fiset L, Milgrom P, Beirne OR, Roy-Byrne P "Disinhibition of behaviors with midazolam: report of a case." J Oral Maxillofac Surg 50 (1992): 645-9
  28. Lobo BL, Miwa LJ "Midazolam disinhibition reaction." Drug Intell Clin Pharm 22 (1988): 725
  29. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical (2001):
  30. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  31. "Product Information. Prosom (estazolam)." Abbott Pharmaceutical (2022):
  32. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
  33. Rush CR, Higgins ST, Hughes JR, Bickel WK "A comparison of the acute behavioral effects of triazolam and temazepam in normal volunteers." Psychopharmacology (Berl) 112 (1993): 407-14
  34. "Product Information. Doral (quazepam)." Wallace Laboratories (2001):
  35. "Product Information. Versed (midazolam)." Roche Laboratories (2001):
View all 35 references
Moderate

Chlordiazepoxide (applies to Librax) porphyria

Moderate Potential Hazard, Moderate plausibility.

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.

References

  1. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories (2001):
Minor

Anticholinergics (applies to Librax) hypertension

Minor Potential Hazard, Moderate plausibility.

Cardiovascular effects of anticholinergics may exacerbate hypertension. Therapy with anticholinergic agents should be administered cautiously in patients with hypertension.

References

  1. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  2. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  3. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  4. Valentin N, Staffeldt H, Kyst A "Effect of i.v. atropine on cardiac rhythm, heart rate, blood pressure and airway secretion during isoflurane anaesthesia." Acta Anaesthesiol Scand 28 (1984): 621-4
  5. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  6. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  7. "Product Information. Atropisol (atropine ophthalmic)." Ciba Vision Ophthalmics (2002):
View all 7 references
Minor

Atropine-like agents (applies to Librax) fever

Minor Potential Hazard, Moderate plausibility.

Atropine-like agents may increase the risk of hyperthermia in patients with fever by producing anhidrosis. Therapy with atropine-like agents should be administered cautiously in febrile patients.

References

  1. Stadnyk AN, Glezos JD "Drug-induced heat stroke." Can Med Assoc J 128 (1983): 957-9
  2. Sarnquist F, Larson CP Jr "Drug-induced heat stroke." Anesthesiology 39 (1973): 348-50
  3. Lee BS "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry 47 (1986): 571
  4. Forester D "Fatal drug-induced heat stroke." JACEP 7 (1978): 243-4
  5. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  6. "Product Information. Cogentin (benztropine)." Merck & Company Inc (2001):
View all 6 references

Librax drug interactions

There are 490 drug interactions with Librax (chlordiazepoxide / clidinium).

Librax alcohol/food interactions

There are 3 alcohol/food interactions with Librax (chlordiazepoxide / clidinium).


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.