클로르디아제폭시드 및 클리디늄

동물 종별 용량

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

• 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)

이상반응

• 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

약물 상호작용

• Digoxin · Pharmacologic effects of digoxin may be increased; clidinium may also increase serum levels of slow-dissolving digoxin.
• CNS Depressants (barbiturates, opiates, anesthetics) · Additive CNS depression and sedative effects.
• Probenecid · May interfere with benzodiazepine metabolism in the liver, causing increased or prolonged effects.
• Rifampin · May induce hepatic microsomal enzymes and decrease the pharmacologic effects of benzodiazepines.
• Cimetidine · May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Erythromycin · May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Fluoxetine · May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Isoniazid · May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Ketoconazole · May decrease chlordiazepoxide metabolism. Additionally, increased gastric pH from clidinium may decrease GI absorption of ketoconazole (administer clidinium 2 hours after ketoconazole).
• Metoprolol · May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Propranolol · May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.

모니터링

• 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)

과용량

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.