Chlordiazepoxide/Amitriptyline, Oral

What are other names for this medicine?

Type of medicine: antidepressant

Generic and brand names: chlordiazepoxide and amitriptyline, oral; Limbitrol; Limbitrol DS

What is this medicine used for?

This medicine is taken by mouth to treat depression and anxiety.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• breathing problems
• chronic constipation or bowel obstruction
• diabetes
• glaucoma
• heart disease or a heart attack
• high or low blood pressure
• liver or kidney disease
• mental illness such as bipolar disorder, paranoia, or schizophrenia
• porphyria (nerve pain or sensitivity to sunlight)
• problems with drug or alcohol abuse
• seizures
• thoughts of suicide
• thyroid problems
• trouble urinating or an enlarged prostate
• trouble swallowing

Females of childbearing age: Do not take this medicine if you are pregnant because it may harm the baby. Tell your healthcare provider if you are pregnant or if you plan to become pregnant. Do not become pregnant during treatment with this medicine. If you become pregnant, contact your healthcare provider right away. Do not breast-feed while taking this medicine.

How do I take it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more of it or take it longer than prescribed. Do not stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually. Stopping too quickly may cause withdrawal symptoms such as seizures.

You may take this medicine with or without food. Take it with a full glass of water.

This medicine may come in different forms. If you have extended-release tablets, do not break, crush, or chew them. Swallow them whole. Ask your pharmacist if you have the extended-release tablets.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider. Do not stop taking this medicine without your healthcare provider's approval. You may need to reduce your dose slowly to avoid withdrawal symptoms.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: restlessness, confusion, seizures, severe vomiting, severe dizziness, severe drowsiness, large pupils, fast or irregular heartbeat, fever, chills, hallucinations, muscle stiffness, sweating, coma.

What should I watch out for?

Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Talk with your provider about this.

Behavior changes may be caused by the medicine or by depression or another mental illness. Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior, such as:

• more outgoing or aggressive behavior than normal
• confusion
• hallucinations
• worsening of depression
• suicidal thoughts.

It may take several weeks before you start to feel better. Do not stop taking this medicine unless your healthcare provider tells you to do so. You may have withdrawal symptoms if you stop this medicine abruptly.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicines unless your healthcare provider approves.

This medicine may make you dizzy or drowsy or cause blurred vision. Do not drive or operate machinery unless you are fully alert.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are taking this medicine.

You may need regular blood tests to find out how this medicine affects you. Keep all appointments for these tests.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

This medicine may cause dry mouth. Sucking hard candy, taking sips of water, or chewing sugarless gum may help.

This medicine may make your skin more sensitive to the sun, which may lead to painful sunburns. While you are taking this medicine, avoid long exposure to the sun. Wear protective clothing, a hat, and sunscreen lotion when you need to be outdoors. Do not use a sunlamp. If you get a severe sunburn, contact your healthcare provider right away.

Diabetics: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Chest pain; chills; dark urine; fast or irregular heartbeat; hallucinations; high fever; rash; heavy sweating; lightheadedness and fainting; loss of bladder control; muscle or joint pain; numbness or tingling in the hands or feet; prolonged erection; seizures; severe confusion; severe drowsiness; severe muscle stiffness; thoughts of suicide; trouble urinating; twitching or involuntary movement of your body or face; unusual excitement; yellowing of your eyes or skin; unexplained sore throat; mouth sores.

Other: Abnormal dreams, vision problems, constipation, diarrhea, dizziness, drowsiness, dry mouth, increased appetite, increased or decreased interest in sex, lightheadedness, nausea, trouble sleeping, weight gain or loss, headache, change in sense of taste, bloating.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• antacids such as Maalox, Mylanta, and Tums (take them 2 hours apart from this medicine)
• antiarrhythmics (medicine to treat irregular heartbeat) such as amiodarone (Cordarone, Pacerone), flecainide (Tambocor), procainamide (Pronestyl), propafenone (Rythmol), and quinidine
• antibiotics such as clarithromycin (Biaxin), erythromycin (Erythrocin, EES, E-Mycin, EryPed), ciprofloxacin (Cipro), levofloxacin (Levaquin), norfloxacin (Noroxin), ofloxacin (Floxin), trovafloxacin (Trovan), metronidazole (Flagyl), rifampin (Rifampin, Rimactane), and rifabutin (Mycobutin)
• anticholinergic medicines such as amantadine (Symmetrel), procyclidine (Kemadrin), trihexyphenidyl (Artane) dicyclomine (Bentyl), atropine sulfate, belladonna, propantheline (Pro-Banthine), methscopolamine (Pamine), benztropine (Cogentin), hyoscyamine (Levsin), ipratropium (Atrovent), scopolamine (Isopto Hyoscine, Transderm Scop), and tolterodine (Detrol)
• antidepressants such as duloxetine (Cymbalta), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), nefazodone, citalopram (Celexa), escitalopram (Lexapro) bupropion (Wellbutrin, Zyban), sertraline (Zoloft), amitriptyline, amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventyl), protriptyline (Vivactil), and trimipramine (Surmontil)
• antiseizure medicines such as carbamazepine (Tegretol), primidone (Mysoline), gabapentin (Neurontin), felbamate (Felbatol), lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), oxcarbazepine (Trileptal), tiagabine (Gabitril), phenytoin (Dilantin), and valproic acid (Depakote, Depakene)
• antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• antihistamines such as diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril), chlorpheniramine (Chlor-Trimeton), and clemastine (Tavist)
• antinausea medicines such as prochlorperazine (Compazine) and promethazine (Phenergan)
• antipsychotic medicines such as chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), loxapine (Loxitane), perphenazine, pimozide (Orap), trifluoperazine (Stelazine), thioridazine, haloperidol (Haldol), clozapine (Clozaril), risperidone (Risperdal), lithium (Eskalith, Eskalith CR, Lithobid), and olanzapine (Zyprexa)
• anti-HIV medicines such as saquinavir (Invirase, Fortovase), ritonavir (Norvir, Kaletra), indinavir (Crixivan), nelfinavir (Viracept), and amprenavir (Agenerase)
• barbiturates such as phenobarbital, butabarbital (Butisol), and pentobarbital (Nembutal)
• benzodiazepines such as alprazolam (Xanax), diazepam (Valium), triazolam (Halcion), and lorazepam (Ativan)
• beta blockers such as metoprolol (Lopressor), atenolol (Tenormin), acebutolol (Sectral), betaxolol (Kerlone), carteolol, bisoprolol (Zebeta), pindolol, timolol, sotalol (Betapace), nadolol (Corgard), labetalol (Normodyne, Trandate), carvedilol (Coreg), and propranolol (Inderal)
• birth control pills and estrogen products such as estradiol (Estrace, Estratab), conjugated estrogens (Premarin), norethindrone (Aygestin, Micronor), norgestrel (Ovrette), megestrol (Megace), and medroxyprogesterone (Provera, Curretab, Cycrin)
• buspirone (BuSpar)
• calcium channel blockers such as diltiazem (Cardizem), nifedipine (Adalat, Procardia), isradipine (DynaCirc), felodipine (Plendil), nicardipine (Cardene), and verapamil (Calan, Isoptin)
• cold and flu medicines, especially antihistamines and decongestants
• cyclosporine (Sandimmune, Neoral, Gengraf)
• diabetes medicines such as insulin, chlorpropamide (Diabinese), tolazamide (Tolinase), glyburide (DiaBeta, Micronase), glipizide (Glucotrol), repaglinide (Prandin), metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone (Actos)
• digoxin (Lanoxin)
• disulfiram (Antabuse)
• epinephrine
• ergotamine tartrate (Ergomar)
• heartburn medicines such as famotidine (Pepcid, Pepcid AC, Pepcid Complete), nizatidine (Axid), and ranitidine (Zantac, Zantac 75), and cimetidine (Tagamet)
• herbal remedies such as St. John's wort, kava, gotu kola, valerian root, and SAMe
• isoniazid (Laniazid, Nydrazid)
• linezolid (Zyvox)
• MAO inhibitor antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate) (Do not take an MAO inhibitor and this medicine within 14 days of each other)
• medicines to relax your intestines such as atropine sulfate (Atropair), clidinium bromide (Quarzan), glycopyrrolate (Robinul), mepenzolate bromide (Cantil), and propantheline bromide (Pro-Banthine)
• medicines to treat Parkinson's disease such as bromocriptine (Parlodel), carbidopa/levodopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), cabergoline (Dostinex), and entacapone (Comtan)
• medicines used to treat high blood pressure such as guanabenz, guanfacine (Tenex), and clonidine (Catapres)
• methylphenidate (Concerta, Metadate CD, Methylin, Ritalin, Ritalin LA, Ritalin SR)
• metoclopramide (Reglan)
• muscle relaxants such as cyclobenzaprine (Flexeril), carisoprodol (Soma), tizanidine (Zanaflex), methocarbamol (Robaxin), and baclofen (Lioresal)
• narcotics such as codeine, morphine, oxycodone (OxyContin), hydromorphone (Dilaudid), propoxyphene (Darvon, Darvon-N, Darvocet, Wygesic), and combination products such as Vicodin, Tylox, Percocet, Percodan, Tylenol #3
• nicotine (smoking) and nicotine deterrent medicine such as Habitrol, NicoDerm, Nicorette, Commit, NicoDerm CQ, Nicotrol Inhaler, Nicotrol NS, Nicotrol Patch
• omeprazole (Prilosec)
• procarbazine (Matulane)
• sedatives such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata)
• theophylline
• thyroid medicines such as Thyroid USP, levothyroxine (Synthroid, Levothroid), liothyronine (Cytomel), and liotrix (Thyrolar)
• warfarin (Coumadin)

Do not drink alcohol while you are taking this medicine.

The effects of this medicine may be increased if you take it with grapefruit juice. Talk with your healthcare provider about this.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.