氯二氮平與克利idinium

用途

• As an anxiolytic
• Behavior indications (thunderstorm/noise phobias)
• Symptomatic treatment of irritable bowel syndrome
• Symptomatic treatment of irritable bowel syndrome

給藥方式

可能的副作用

• 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

注意事項與禁忌

• 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)
• > **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.

藥物相互作用

• Digoxin: Pharmacologic effects of digoxin may be increased; clidinium may also increase serum levels of slow-dissolving digoxin.
• CNS Depressants (barbiturates, opiates, anesthetics): Additive CNS depression and sedative effects.
• Probenecid: May interfere with benzodiazepine metabolism in the liver, causing increased or prolonged effects.
• Rifampin: May induce hepatic microsomal enzymes and decrease the pharmacologic effects of benzodiazepines.
• Cimetidine: May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Erythromycin: May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Fluoxetine: May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Isoniazid: May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Ketoconazole: May decrease chlordiazepoxide metabolism. Additionally, increased gastric pH from clidinium may decrease GI absorption of ketoconazole (administer clidinium 2 hours after ketoconazole).
• Metoprolol: May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Propranolol: May decrease the metabolism of chlordiazepoxide, leading to excessive sedation.
• Anticholinergic Agents / Antihistamines / TCAs: May enhance the anticholinergic activity and toxicity of clidinium.
• Amitraz: Antimuscarinics may aggravate signs of amitraz toxicity, leading to hypertension and further inhibition of peristalsis.
• Antacids: May decrease PO absorption of clidinium; give at least 1 hour prior to oral antacids.
• Corticosteroids: Long-term use concurrently with antimuscarinics may increase intraocular pressure.
• Metoclopramide: Clidinium and other antimuscarinics may antagonize the prokinetic actions of metoclopramide.

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