클로르디아제폭시드 및 클리디늄
Chlordiazepoxide and Clidinium
Chlordiazepoxide hydrochloride; Clidinium bromide
다른 이름: Librium · Librax · chlordiazepoxidi hydrochloridum · methamino-diazepoxide hydrochloride · NSC-115748 · Ro5-0690
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| As an anxiolytic | 0.5-1 mg/kg | PO | q12-24h | — | 🌎 NA |
- As an anxiolytic: Chlordiazepoxide alone
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
클로르디아제폭시드는 주로 항불안 및 경미한 진정 효과를 위해 사용되는 지속성 벤조디아제핀계 약물입니다. 클리디늄 브롬화물은 위장관 운동과 경련을 감소시키는 합성 4급 암모늄 항무스카린(항콜린) 제제입니다.
수의학에서 이 약물들은 단독으로 또는 병용하여 사용되기도 합니다:
- 클로르디아제폭시드 단독: 반려견의 소음 공포증이나 반려묘의 고양이 간 공격성 및 소변 스프레이와 같은 행동 장애의 보조 요법으로 사용됩니다.
- 클로르디아제폭시드 + 클리디늄 (Librax®): 이 복합제는 반려견의 과민성 대장 증후군(IBS)과 같은 스트레스 유발성 위장관 질환을 치료하는 데 독특한 위치를 차지합니다. 중추성 불안 요소(클로르디아제폭시드)와 말초성 위장 경련(클리디늄)을 동시에 해결합니다.
임상 팁: 클리디늄은 4급 아민이기 때문에 혈액-뇌 장벽을 쉽게 통과하지 못하여, 아트로핀에서 흔히 볼 수 있는 중추성 항콜린 부작용을 피할 수 있습니다.
작용 기전
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.
안전성·주의사항
금기사항
- 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)
부작용
- 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
주의
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.
약물 상호작용
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.
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)
약동학
흡수
Chlordiazepoxide is rapidly absorbed following oral administration. Clidinium is incompletely absorbed from the small intestine.
분포
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.
대사
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.
배설
Both drugs and their metabolites are eliminated primarily in the urine.
과다투여
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.
제품
제형
- Oral Capsules
인용의약품
- Chlordiazepoxide HCl Oral Capsules: 5 mg, 10 mg & 25 mg
- Chlordiazepoxide HCl 5 mg and Clidinium Br 2.5 mg Capsules (Librax®)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Chlordiazepoxide HCl capsules/tablets and combination capsules should be stored at room temperature in tight, light-resistant containers.
보호자 정보
- 투여 방법: 수의사의 지시에 따라 정확하게 투여하십시오. 스트레스 관련 설사에 사용하는 경우, 경련의 첫 징후가 나타나거나 스트레스 상황이 발생할 때 투여하십시오.
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- 안전: 어린이와 다른 반려동물의 손이 닿지 않는 곳에 엄격히 보관하십시오. 단단히 닫힌 용기에 보관하십시오.
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