Chlordiazepoxide drug interactions

A San Francisco woman with a history of diabetes and high blood pressure was hospitalized in January 2001 with a life-threatening low blood sugar concentration after she consumed Anso Comfort capsules (260). The authors conjectured that hospitalization may have been necessitated by a drug interaction of chlordiazepoxide with medications that she was taking for other medical conditions. 

File, Si. The use of social interaction as a method for detecting anxiolytic activity of chlordiazepoxide-like drugs. J. NeuroscL Methods 2 219—238, 1980. 

Oral contraceptives alter the metabolism of some benzodiazepines that undergo oxidation (chlordiazepoxide, alprazolam, diazepam) or nitroreduction (nitrazepam) (334). Oral contraceptives inhibit enzyme activity and reduce the clearances of these drugs. There is nevertheless no evidence that these interactions are of clinical importance. For other benzodiazepines that undergo oxidative metabolism, such as bromazepam and clotiazepam, no change has ever been found in oral contraceptive users. 

Corticosteroids interact with barbiturates, carbamazepine, phenytoin, primidone, frusemide, thiazide, NSAIDs, antidiabetics, and antihypertensive drugs. Benzquinamide hydrochloride is incompatible with chlordiazepoxide, diazepam, and some barbiturates. Care should be exercised when handling bisacodyl to avoid contact with skin and mucosal membranes. 

None of the interactions between the benzodiazepines and antiepileptics described here appear to be of major clinical importance, with the possible exception of the interaction between clobazam and felbamate. If both drugs are given be aware that additive sedative or other adverse effects may occur. This may also be possible in some rare cases with chlordiazepoxide or clobazam and phenobarbital clonazepam and lamotrigine or primidone and clorazepate and primidone. 

The documentation of these interactions is limited but what has been reported is consistent with the way rifampicin interacts with many other drugs. The clinical importance of some of these interactions between the benzodiazepines and related drugs and rifampicin has not yet been assessed but what is known suggests that the dosage of diazepam and nitrazepam may need to be increased if rifampicin is given. Be alert for a reduction in the effects of other similarly metabolised benzodiazepines (e.g. chlordiazepoxide, flurazepam). 

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