metabolism. Use Caution/Monitor.Minor (1)voriconazole increases levels of chlordiazepoxide by decreasing metabolism. Minor/Significance Unknown.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.xylometazolineMonitor Closely (1)chlordiazepoxide increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)chlordiazepoxide increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)chlordiazepoxide and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)chlordiazepoxide and ziprasidone both increase sedation. Use Caution/Monitor.zolpidemMinor (1)zolpidem, chlordiazepoxide. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.zotepineMonitor Closely (1)chlordiazepoxide and zotepine both increase sedation. Use Caution/Monitor. >10% Ataxia Drowsiness Memory impairment Sedation Muscle weakness Rash Decreased libido Menstrual disorders Xerostomia Salivation decreased Increased/decreased appetite Weight gain/loss Micturition difficulties 1-10% Confusion Dizziness Disinhibition Akathisia Dermatitis Hypotension Salivation increased Sexual dysfunction Incontinence Rigidity Tremor Muscle cramps Tinnitus Nasal congestion Black Box Warnings Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation Addiction, abuse, and misuse On September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death Physical dependence can occur when taken steadily for several days to weeks, even as prescribed Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening Assess each patient’s risk prior to prescribing and monitor regularly for the development of these behaviors or conditions Contraindications Documented hypersensitivity to drug or component of the formulation Cautions Patient should be observed for up to 3 hours following administration Anterograde amnesia associated with treatment Use caution in renal and hepatic impairment Use caution in respiratory disease (COPD), sleep apnea, porphyria, open-angle glaucoma (questionable), depression, suicidal ideation, impaired gag reflex May impair ability to perform hazardous tasks Paradoxical reactions, including hyperactive or aggressive behavior, reported Use caution in patients with depression, especially if suicidal risk present Ataxia and oversadation may occur in the elderly and debilitated patients; there also increased risk of falls Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use Pregnancy category: D Lactation: Enters breast milk/not recommendedPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through the GABA receptor system. Increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane Absorption Bioavailability: Slow and erratic following IM admin Onset: 1-5 min (IV) Duration: 15-60 min (IV) Plasma peak time: Within 2 hr Distribution Protein bound: 90-98% Vd: 3.3 L/kg Metabolism Metabolites: Demoxepam, desmethylchlordiazepoxide, desmethyldiazepam, oxazepam Elimination Half-life: 6-25 hr (normal liver and renal function); 5-30 hr (end-stage renal disease); 30-63 hr (liver cirrhosis) Excretion: Urine IV Incompatibilities Solution: NS(?) Y-site: Cefepime IV Compatibilities Solution: D5W, LR Y-site: Heparin, hydrocortisone Na-succinate, KCl, vitamin B/C IV Administration Preferred over IM due to erratic IM absorption Slow IVP over >1 min: Rapid administration can cause hypotension, slow respiration, bradycardia Have airway support available until effects of IV administration known Patient should be observed for up to 3 hr following administration Monitor respiration q5-15min after use and before each repeated dose No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. OR Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription. Plans Select State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Done Non-Medicare Plans Medicare Plans Done CLOSE Additional Offers CLOSE Email to Patient From: To: The recipient will receive more details and instructions to access this offer. By clicking send, you acknowledge that you have permission to email the recipient with this information. 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