Clordiazepóxido y Clidinio
Chlordiazepoxide and Clidinium
Chlordiazepoxide hydrochloride; Clidinium bromide
También conocido como: Librium · Librax · chlordiazepoxidi hydrochloridum · methamino-diazepoxide hydrochloride · NSC-115748 · Ro5-0690
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Behavior indications (thunderstorm/noise phobias) | 2.2-6.6 mg/kg | PO | as needed | — | 🌎 NA |
| Symptomatic treatment of irritable bowel syndrome | 0.1-0.25 mg/kg of clidinium or 1-2 capsules | PO | two times to three times a day | Discontinued in a few days | 🌎 NA |
| Symptomatic treatment of irritable bowel syndrome | 0.44-1.1 mg/kg of clidinium | PO | two to three times a day | 1 day to 2 weeks (some require long-term treatment at 1-2 doses per day) | 🌎 NA |
- Behavior indications (thunderstorm/noise phobias): Chlordiazepoxide alone; start low
- Symptomatic treatment of irritable bowel syndrome: Using the combination product (e.g., Librax). Give when abdominal pain or diarrhea first noticed or if stressful conditions are encountered.
- Symptomatic treatment of irritable bowel syndrome: Using the combination product (e.g., Librax). Use at first signs of cramping or abdominal pain.
Gatos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| As an anxiolytic | 0.5-1 mg/kg | PO | q12-24h | — | 🌎 NA |
- As an anxiolytic: Chlordiazepoxide alone
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
El clordiazepóxido es una benzodiazepina de acción prolongada utilizada principalmente por sus propiedades ansiolíticas y sedantes leves. El bromuro de clidinio es un agente antimuscarínico (anticolinérgico) de amonio cuaternario sintético que reduce la motilidad y los espasmos gastrointestinales.
En medicina veterinaria, estos fármacos se utilizan ocasionalmente solos o en combinación:
- Clordiazepóxido solo: Se utiliza como complemento para trastornos del comportamiento, como fobias a ruidos en perros, o agresividad entre gatos y marcaje con orina en felinos.
- Clordiazepóxido + Clidinio (Librax®): Esta combinación está diseñada específicamente para tratar trastornos gastrointestinales inducidos por estrés, como el Síndrome del Intestino Irritable (SII) en perros. Aborda tanto el componente de ansiedad central (mediante el clordiazepóxido) como los espasmos gastrointestinales periféricos (mediante el clidinio).
Perla clínica: Debido a que el clidinio es una amina cuaternaria, no atraviesa fácilmente la barrera hematoencefálica, evitando así los efectos secundarios anticolinérgicos centrales que se observan comúnmente con la atropina.
Mecanismo de acción
The combination product exerts its effects through two distinct mechanisms targeting the central nervous system and the peripheral gastrointestinal tract:
- Chlordiazepoxide (Anxiolytic/Sedative): Binds to the benzodiazepine allosteric site on the GABA-A receptor complex in the CNS → enhances the affinity of the receptor for the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) → increases the frequency of chloride channel openings → neuronal hyperpolarization. This dampens activity in the limbic system, thalamus, and hypothalamus, producing anxiolytic, muscle relaxant, and anticonvulsant effects.
- Clidinium (Antispasmodic): Acts as a competitive antagonist at muscarinic acetylcholine receptors (primarily M3 receptors in the gut) → inhibits parasympathetic nerve impulses → significantly reduces gastrointestinal smooth muscle spasms, motility, and gastric acid secretion.
Seguridad y advertencias
Contraindicaciones
- Known hypersensitivity to benzodiazepines or antimuscarinics
- Coma, shock, or significant respiratory depression
- Aggressive patients (may disinhibit bite inhibition and worsen aggression)
- Tachycardia secondary to thyrotoxicosis or cardiac insufficiency
- Myocardial ischemia
- Gastrointestinal obstructive disease or paralytic ileus
- Severe ulcerative colitis
- Obstructive uropathy
- Myasthenia gravis
- Known or suspected GI infections (may prolong retention of toxins/pathogens)
Efectos adversos
- Paradoxical CNS excitement or agitation (especially in dogs)
- Variable sedation and lethargy
- Behavioral changes (irritability, aberrant demeanor in cats)
- Potential hepatotoxicity (idiosyncratic hepatic failure reported with oral diazepam in cats; unknown if chlordiazepoxide shares this risk)
- Dry mouth (xerostomia)
- Constipation or dysphagia
- Urinary retention or hesitancy
- Tachycardia (at higher doses) or initial bradycardia
Precauciones
Warning: Use benzodiazepines with extreme caution in aggressive animals, as they may disinhibit anxiety-based bite inhibition, leading to worsened aggressive behavior.
- Hepatic/Renal Impairment: Use cautiously in patients with liver or kidney disease, and in debilitated or geriatric patients.
- Working Animals: Benzodiazepines may impair the abilities of working or service animals.
- Autonomic Neuropathy: Use antimuscarinics with extreme caution.
- Pregnancy: Benzodiazepines are potentially teratogenic (FDA Category D). Use during the first trimester only if benefits clearly outweigh risks.
- Nursing: Distributed into milk and may cause CNS effects in nursing neonates.
Interacciones farmacológicas
Pharmacologic effects of digoxin may be increased; clidinium may also increase serum levels of slow-dissolving digoxin.
Additive CNS depression and sedative effects.
May interfere with benzodiazepine metabolism in the liver, causing increased or prolonged effects.
May induce hepatic microsomal enzymes and decrease the pharmacologic effects of benzodiazepines.
May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
May decrease chlordiazepoxide metabolism. Additionally, increased gastric pH from clidinium may decrease GI absorption of ketoconazole (administer clidinium 2 hours after ketoconazole).
May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
May enhance the anticholinergic activity and toxicity of clidinium.
Antimuscarinics may aggravate signs of amitraz toxicity, leading to hypertension and further inhibition of peristalsis.
May decrease PO absorption of clidinium; give at least 1 hour prior to oral antacids.
Long-term use concurrently with antimuscarinics may increase intraocular pressure.
Clidinium and other antimuscarinics may antagonize the prokinetic actions of metoclopramide.
Monitorización
- Clinical efficacy (reduction in anxiety, resolution of GI spasms/diarrhea)
- Adverse effects (excessive sedation, paradoxical excitement, anticholinergic signs)
- Baseline and periodic liver function tests in cats (due to idiosyncratic hepatotoxicity risks associated with oral benzodiazepines)
Farmacocinética
Absorción
Chlordiazepoxide is rapidly absorbed following oral administration. Clidinium is incompletely absorbed from the small intestine.
Distribución
Chlordiazepoxide is highly lipid soluble, widely distributed, fairly highly bound to plasma proteins, and readily crosses the blood-brain barrier. Clidinium is completely ionized in vivo and does not appreciably cross into the CNS or the eye.
Metabolismo
Chlordiazepoxide is metabolized in the liver to several active metabolites (desmethyldiazepam, desmethylchlordiazepoxide, oxazepam) which have considerable half-lives. Clidinium is metabolized principally in the liver.
Eliminación
Both drugs and their metabolites are eliminated primarily in the urine.
Sobredosis
Overdoses of chlordiazepoxide alone are generally limited to significant CNS depression (confusion, coma, decreased reflexes). Hypotension, respiratory depression, and cardiac arrest are possible but rare.
Treatment:
- Standard protocols for acute oral toxicity (gastric decontamination, binding agents like activated charcoal).
- Supportive systemic measures (fluids, cardiovascular support).
- Flumazenil may be considered as a specific reversal agent for severe benzodiazepine-induced CNS depression.
- Analeptic agents (CNS stimulants like caffeine) are generally not recommended.
Productos disponibles
Formulaciones
- Oral Capsules
Etiquetado para humanos
- Chlordiazepoxide HCl Oral Capsules: 5 mg, 10 mg & 25 mg
- Chlordiazepoxide HCl 5 mg and Clidinium Br 2.5 mg Capsules (Librax®)
Estado regulador
Sin datos reguladores para: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Chlordiazepoxide HCl capsules/tablets and combination capsules should be stored at room temperature in tight, light-resistant containers.
Información para el cliente
- Administración: Administre exactamente según las indicaciones de su veterinario. Si se utiliza para diarrea relacionada con el estrés, administre al primer signo de calambres o eventos estresantes.
- Cambios de comportamiento: En algunos animales (especialmente perros), este medicamento puede causar excitación paradójica o agitación en lugar de calmarlos. Notifique a su veterinario de inmediato si el comportamiento de su mascota empeora o si se vuelve agresiva.
- Efectos secundarios: Puede causar sequedad de boca (asegúrese de que siempre haya agua fresca disponible), estreñimiento o somnolencia leve.
- Gatos: Observe de cerca si hay pérdida de apetito, vómitos, letargo o coloración amarillenta en los ojos/encías, ya que los medicamentos ansiolíticos orales de esta clase pueden causar problemas hepáticos en gatos en casos raros.
- Seguridad: Mantenga estrictamente fuera del alcance de niños y otras mascotas. Almacene en un recipiente herméticamente cerrado.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.