How does this medication work? What will it do for me?
Chlordiazepoxide belongs to the class of medications called benzodiazepines. Clidinium belongs to the class of medications called anticholinergics. Chlordiazepoxide and clidinium are a combination of medications used to treat stomach and intestinal problems such as irritable bowel syndrome (IBS) and ulcers, particularly if there is anxiety associated with the condition.
Chlordiazepoxide - clidinium helps by reducing the amount of acid formed in your stomach as well as by relieving the pain of stomach spasms and abdominal cramps. Often, relief from symptoms occurs with the first couple of doses.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each green opaque, No. 4 capsule contains 5 mg of chlordiazepoxide HCl and 2.5 mg of clidinium bromide. Nonmedicinal ingredients: lactose, microcrystalline cellulose, stearic acid, and talc; capsule: D&C Yellow No. 10, edible black ink (black iron oxide; may contain pharmaceutical glaze, FD&C Blue No. 2 Aluminum Lake, FD&C Red No. 40 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake, D&C Yellow No. 10 Aluminum Lake, n-butyl alcohol, propylene glycol, SDA-3A alcohol, pharmaceutical shellac, ethyl alcohol, isopropyl alcohol, ammonium hydroxide, and potassium hydroxide), FD&C Blue No. 1, FD&C Yellow No. 6, gelatin, silicon dioxide, sodium lauryl sulfate, and titanium dioxide.
How should I use this medication?
The recommended adult dose of this medication is 1 or 2 capsules taken 1 to 4 times a day. The medication is started with 1 or 2 capsules daily and gradually increased by your doctor until an appropriate dose is reached. No more than 8 capsules should be taken each day. For seniors, the dose should start at 1 capsule 2 times daily, with adjustment to the dose as needed and tolerated. It is important that the dose be individualized to your specific needs to avoid excessive sedation or motor impairment.
The capsules should be taken 30 to 60 minutes before a meal, unless otherwise instructed by your doctor.
This medication may be habit-forming when taken for long periods of time. If you have been taking this medication regularly for a long period of time (i.e., more than 1 month), do not stop taking the medication without first speaking with your doctor. To avoid withdrawal effects, a gradual dose reduction is usually recommended when stopping this medication.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If your next dose is in less than 4 hours, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Chlordiazepoxide - clidinium should not be taken by anyone who:
- is allergic to clidinium, chlordiazepoxide, any other medications belonging to the benzodiazepine class, or to any of the ingredients of the medication
- is breast-feeding
- is pregnant or planning to become pregnant
- has a hiatus hernia with reflux esophagitis
- has a history of drug abuse or dependence
- has an enlarged prostate
- has active heart problems
- has difficulty urinating
- has glaucoma
- has intestinal atony ("lazy bowel")
- has liver disease
- has myasthenia gravis
- has ulcerative colitis
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- bloated feeling
- decreased sexual ability
- decreased sweating
- dry mouth
- trouble sleeping
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- nervousness or irritability
- prolonged constipation
- shortness of breath
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
- skin rash or hives
- slow heartbeat
- symptoms of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
- unusual excitement
Stop taking the medication and seek immediate medical attention if any of the following occur:
- Symptoms of overdose:
- difficult urination
- drowsiness (severe)
- dryness of nose, mouth, throat (severe)
- fast heartbeat
- unusual warmth, dryness, and flushing of skin
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Alcohol and other medications that cause drowsiness: Do not consume alcohol while taking this medication, as this may lead to dangerous side effects. Other medications that cause drowsiness or slow down your breathing (e.g., antidepressants, sleeping pills, anxiety medications) should be avoided if possible as additive side effect may occur and can be dangerous.
Body temperature: This medication may decrease the amount of sweat that is created in an effort to control body temperature. People who exercise vigorously, are exposed to extreme heat, are dehydrated, or are taking other anticholinergic medications (e.g., benztropine, oxybutynin) are more at risk. Contact your doctor as soon as possible if you feel very hot and are unable to cool.
Exposure to extreme heat or being in heat for a long period of time can result in severe overheating that can be fatal.
Breathing Problems: This medication can cause the mucus and secretions in the lungs to become dry and difficulty to cough up. If you have asthma or chronic obstructive pulmonary disease (COPD; emphysema, chronic bronchitis) you may experience increased difficulty breathing. If you have breathing problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Constipation/Intestinal Blockage: Clidinium slows down the speed at which things travel through the digestive system and may cause constipation. If constipation develops, talk to your doctor or pharmacist as soon as possible.
Dental problems: Clidinium can cause dry mouth, which increases the risk of dental disease. You should see your dentist regularly and let your dentist know about this and any other medications you may be taking.
Dependence and withdrawal: Physical dependence (a need to take regular doses to prevent physical symptoms) has been associated with benzodiazepines such as chlordiazepoxide - clidinium. Severe withdrawal may occur if the dose is significantly reduced or suddenly discontinued. These symptoms include seizures, irritability, nervousness, sleep problems, agitation, tremors, diarrhea, abdominal cramps, vomiting, memory impairment, headache, muscle pain, extreme anxiety, tension, restlessness, and confusion. Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms.
Depression: Chlordiazepoxide may cause depression or make the symptoms of depression worse. If you have depression or a history of depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking this medication, contact your doctor as soon as possible.
Drowsiness/reduced alertness: Because chlordiazepoxide - clidinium may cause drowsiness and sedation, do not engage in activities that require mental alertness, judgment, and physical coordination (such as driving or operating machinery) while taking this medication. This is particularly true when first starting the medication and until you have established that chlordiazepoxide - clidinium does not affect you this way. Alcohol ingestion can increase the drowsiness effects and should be avoided.
Glaucoma: This medication may make the symptoms of glaucoma worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
High Blood Pressure: High blood pressure can be aggravated by this medication. If you have a history of high blood pressure or are taking medications for high blood pressure, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Myasthenia Gravis: Chlordiazepoxide - clidinium may cause symptoms of myasthenia gravis to worsen. If you have myasthenia gravis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Prostate enlargement: The symptoms of prostate enlargement may be made worse by this medication. If you have prostate enlargement or another problem involving the prostate gland, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Thyroid problems: The symptoms of overactive thyroid may be worsened by this medication. If you have an overactive thyroid, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring.
Pregnancy: Chlordiazepoxide crosses the placenta and may cause harm to the developing baby if it is taken by the mother during pregnancy. This medication should not be used during pregnancy unless the benefits outweigh the risks.
Breast-feeding: This medication may pass into breast milk. Clidinium may decrease the amount of breast milk that is produced if taken while breast-feeding. If you are a breast-feeding mother and are taking chlordiazepoxide - clidinium, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children.
Seniors: Seniors may be at increased risk for the sedative and impaired coordination effects of this medication. They need to use extra caution, for example, when getting up during the night.
What other drugs could interact with this medication?
There may be an interaction between chlordiazepoxide - clidinium and any of the following:
- antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
- antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- barbiturates (e.g., butalbital, pentobarbital phenobarbital)
- benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
- botulinum toxin
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- chloral hydrate
- general anesthetics (medications used to put people to sleep before surgery)
- grapefruit juice
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine)
- muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
- narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
- potassium chloride
- protein kinase inhibitors (e.g., crizotinib, dabrafenib, idelalisib, imatinib)
- St. John's wort
- seizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
- sodium oxybate
- theophyllines (e.g., aminophylline, oxtriphylline)
- thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
- tricyclic antidepressants (e.g., clomipramine, desipramine, imipramine)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.