Psychotropic Use during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Chlordiazepoxide is a benzodiazepine tranquilizer that has less potency than diazepam on a milligram basis. It also has less anticonvulsant, muscle relaxant and sedative properties, but is effective in treating alcohol withdrawal. In several cohort studies, the frequency of congenital defects was not increased among more than 480 newborns whose mothers had first-trimester exposure to chlordiazepoxide (Crombie et al., 1975; Hartz et al., 1975; Heinonen et al., 1977; Kullander and Kallen, 1976a, 1976b). Two case-control studies reported no association between maternal use of this benzodiazepine in the first trimester and congenital defects (Bracken and Holford, 1981; Rothman et al., 1979). In contrast, in a small cohort study an association was reported between congenital malformations in 35 infants and maternal use of chlordiazepoxide in the first 42 days of gestation (Milkovich and van den Berg, 1974). However, there was no pattern to the anomalies observed.
Prescribing 2
Kerry Layne, Albert Ferro, Janice Rymer in 100 Cases in Clinical Pharmacology, Therapeutics and Prescribing, 2020
Benzodiazepines should be prescribed to manage acute alcohol withdrawal. Chlordiazepoxide is typically the benzodiazepine of choice as it has a relatively low potential for abuse. This is prescribed orally. Patients with impaired liver function should be treated with either a reduced dose of chlordiazepoxide or lorazepam. Intravenous diazepam or lorazepam may be indicated if urgent control is required. This patient does not have significantly impaired liver function, as indicated by his normal liver function tests and INR result. The dose and frequency of benzodiazepines required is usually determined using an objective withdrawal scoring system, such as the ‘Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)’, to identify signs of withdrawal, such as tremor.
Psychiatric Emergencies in Substance Abuse
R. Thara, Lakshmi Vijayakumar in Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
Consider putting the patient on medication. For uncomplicated withdrawal, benzodiazepines are the treatment of choice among which, chlorediazepoxide and lorazepam are the preferred drugs. Depending upon the severity of withdrawal symptoms, the doses can be titrated. Administer chlordiazepoxide, 25 mg or 50 mg, as required, orally every 6 hours for maximum up to 100–150 mg daily in divided doses. Alternatively, one can administer lorazepam, 2 mg (in those with signs and symptoms of hepatic dysfunction) orally every 2–4 hours for maximum up to 8–10 mg daily in divided doses. The dose should be tapered down and stopped over 7–14 days.
Effects of Multiple Detoxifications on Withdrawal Symptoms, Psychiatric Distress and Alcohol-Craving in Patients with an Alcohol Use Disorder
Published in Behavioral Medicine, 2021
Martha Ooms, Hendrik G. Roozen, Juul H. Willering, Wobbe P. Zijlstra, Ranne de Waart, Anna E. Goudriaan
The inpatient detoxification was focused on sustained alcohol abstinence. The previous number of detoxifications was M = 5.09 (SD = 2.86) for the ≥2 previous detoxifications (see Table 1 for detailed information on the group of <2 previous detoxifications). The patients’ medication dosage regimen was based on two protocols.38,39 More than 80% of the patients were medically supported during the withdrawal process. Withdrawal symptoms were in most cases treated with chlordiazepoxide with an average dose of 40 mg – 200 mg q.i.d. Consistent with the protocols, the dosage regimen was frequently tapered within a 7-day period, contingent on observed and self-reported symptoms. In general, after 7-10 days most of the withdrawal symptoms subsided. During the detoxification phase, 36.5% received additional anti-depressants (e.g. venlafaxine, paroxetine), 23.1% sleeping medication (e.g. temazepam, zoplicone), 9.6% benzodiazepines on a maintenance dose (e.g.oxazepam), and 7.7% anti-craving agents (e.g. naltrexone, acamprosate).
Lavandula angustifolia and combination of Lavandula angustifolia and Zataria multiflora administration attenuates prenatal lead-exposed induced learning and memory impairments in male rats
Published in Toxin Reviews, 2018
Farahnaz Taheri, Gholamreza Sepehri, Vahid Sheibani, Khadijeh Esmaeilpour
The mechanism(s) by which LAF ameliorate the lead–induced cognitive impairments in antenatally lead-exposed rats is not precisely determined. In previous studies, LAF extracts showed acetylcholinesterase inhibitory (AChE) effects (Adsersen et al. 2006) and antioxidant activities (Kim and Cho 1999). It is reported that LAF extract has positive effects on spatial learning and memory in male Wistar rats (Rabiei et al. 2014). Adsersen et al. (2006) showed inhibitory effects of LAF on glutamate-induced neurotoxicity (Adsersen et al. 2006). Also, it is reported that aqueous extracts of LAF decrease glutamate-induced neurotoxicity in rat pups cerebellar granular cell culture (Buyukokuroglu et al. 2003). Other investigators studies demonstrated LAF oil has antianxiety effects via linalool as the major pharmacologically active constituent of lavender oil (Umezu et al. 2006, Shaw et al. 2011). The anxiolytic effects oflavender oil is almost similar to chlordiazepoxide and these effects are mediated by paraventricular nucleus of the hypothalamus, the dorsomedial hypothalamic nucleus and the central nucleus of the amygdale (Shaw et al. 2011). Also, antioxidant and weak AchE inhibition property of linalool (one of the main components in lavandula angustifolia oil) is reported (Savelev et al. 2003).
Evaluation of the appropriate use of a CIWA-Ar alcohol withdrawal protocol in the general hospital setting
Published in The American Journal of Drug and Alcohol Abuse, 2018
Amanda S. Eloma, Jason M. Tucciarone, Edmund M. Hayes, Brian D. Bronson
Out of 1912 encounters identified on a CIWA-Ar protocol, a total of 102 patients and 118 encounters were included. The quantity of administered benzodiazepines were converted to lorazepam equivalents (14), and comprised of symptom-triggered, fixed-dose, or off-protocol orders during the entire course of admission. Our AWS standard protocol utilizes scheduled and as needed (PRN) regimens of oral chlordiazepoxide and/or lorazepam in oral or parenteral administration; however, all benzodiazepines administered, including alprazolam, clonazepam, diazepam, temazepam, and zolpidem (a non-benzodiazepine gamma-aminobutyric acid-A receptor agonist) were reviewed. Route of medication administration was noted.
Related Knowledge Centers
- Active Metabolite
- Alcohol
- Amnesia
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- Drug Withdrawal
- Insomnia
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- Sedative
- Hypnotic
- Half-Life