氯二氮平與克利idinium
Chlordiazepoxide and Clidinium
Chlordiazepoxide hydrochloride; Clidinium bromide
別名: Librium · Librax · chlordiazepoxidi hydrochloridum · methamino-diazepoxide hydrochloride · NSC-115748 · Ro5-0690
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| As an anxiolytic | 0.5-1 mg/kg | PO | q12-24h | — | 🌎 NA |
- As an anxiolytic: Chlordiazepoxide alone
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
氯二氮平（Chlordiazepoxide）是一種長效的苯二氮平類藥物，主要用於其抗焦慮和輕度鎮靜作用。克利idinium（Clidinium bromide）是一種合成的四級銨抗蕈毒鹼（抗膽鹼）藥物，可減少胃腸道蠕動和痙攣。
在獸醫學中，這些藥物偶爾會單獨或合併使用：
- 單獨使用氯二氮平：作為行為障礙的輔助治療，例如狗的噪音恐懼症，或貓的貓際攻擊行為和噴尿問題。
- 氯二氮平 + 克利idinium (Librax®)：此複方藥物在治療壓力引起的胃腸道疾病（如狗的大腸激躁症 IBS）方面具有獨特地位。它能同時處理中樞焦慮成分（透過氯二氮平）和周邊胃腸痙攣（透過克利idinium）。
臨床要點：由於克利idinium是一種四級胺，它不易穿過血腦屏障，因此避免了阿托品（atropine）常見的中樞抗膽鹼副作用。
作用機轉
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.
安全性與警告
禁忌症
- 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)
不良反應
- 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
注意事項
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.
藥物交互作用
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.
監測
- 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)
藥物動力學
吸收
Chlordiazepoxide is rapidly absorbed following oral administration. Clidinium is incompletely absorbed from the small intestine.
分佈
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.
代謝
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.
排除
Both drugs and their metabolites are eliminated primarily in the urine.
過量
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.
可用產品
劑型
- Oral Capsules
人用標示
- Chlordiazepoxide HCl Oral Capsules: 5 mg, 10 mg & 25 mg
- Chlordiazepoxide HCl 5 mg and Clidinium Br 2.5 mg Capsules (Librax®)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Chlordiazepoxide HCl capsules/tablets and combination capsules should be stored at room temperature in tight, light-resistant containers.
飼主須知
- 給藥方式：請嚴格按照獸醫師的指示給藥。如果用於治療壓力相關的腹瀉，請在出現痙攣或遇到壓力事件的最初跡象時給藥。
- 行為改變：在某些動物（尤其是狗）中，這種藥物可能會引起矛盾的興奮或焦躁，而不是使其平靜。如果您的寵物行為惡化或變得具有攻擊性，請立即通知您的獸醫師。
- 副作用：可能會引起口乾（請確保隨時提供新鮮飲水）、便秘或輕度嗜睡。
- 貓咪注意事項：密切觀察是否有食慾不振、嘔吐、嗜睡或眼睛/牙齦發黃的現象，因為此類口服抗焦慮藥物極少數情況下可能導致貓咪出現肝臟問題。
- 安全：請嚴格放置於兒童和其他寵物接觸不到的地方。存放在緊閉的容器中。
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