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Chlordiazepoxide

Chlordiazepoxide (marketed under the trade name Librium®) is a hypnotic drug which is a benzodiazepine derivative. It has sedative, anxiolytic and skeletal muscle relaxant properties. more...

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History

Chlordiazepoxide was the first benzodiazepine to be synthesized and made commercially available. It was an accidental discovery made by Leo Sternbach of Roche Pharmaceuticals in 1960. It has a medium to long half life.

Sternbach later went on to develop diazepam, better known as Valium, in 1963. The huge success of Valium made Roche the market leader in benzodiazepine products, and the company went on to develop and market nitrazepam in 1965 and later flurazepam and flunitrazepam in 1975.

Other drug companies soon jumped on board the benzodiazepine band wagon, with Wyeth's lorazepam and Upjohn (now Pfizer)'s alprazolam.

As prescriptions for benzodiazepines sky-rocketed through the late 1960s and 1970s, the problem of dependency began to emerge. However, chlordiazepoxide is still a useful treatment for patients suffering from acute anxiety. It is still manufactured and prescribed today, along with a wide variety of other benzodiazepines, all of which have similar properties.

Pharmacology

Chlordiazepoxide is believed to act on the GABA_A receptor, thereby producing inhibitory effects similar to the other benzodiazepines.

Indications

Chlordiazepoxide is indicated for the treatment of insomnia, anxiety and panic attacks. It has also been used as a treatment for acute alcohol or opiate withdrawl.

Dosage

Chlordiazepoxide is available in dosages of 5mg, 10mg and 25mg.

Side Effects

Common side effects of chlordiazepoxide include:

Drowsiness
Depression
Impaired motor function
- Impaired coordination
- Impaired balance
- Dizziness
Nervousness
Anterograde amnesia (especially pronounced in higher doses)

Contraindications

Use of chlordiazepoxide should be avoided in individuals with the following conditions:

Myasthenia gravis
Acute intoxication with alcohol, narcotics, or other psychoactive substances
Ataxia
Severe hypoventilation
Acute narrow-angle glaucoma
Severe liver deficiencies (hepatitis and liver cirrhosis decrease elimination by a factor of 2)
Severe sleep apnea
Hypersensitivity or allergy to any drug in the benzodiazepine class

Overdose

An individual who has consumed too much chlordiazepoxide will display one or more of the following symptoms:

Somnolence (difficulty staying awake)
Mental confusion
Hypotension
Hypoventilation
Impaired motor functions
- Impaired reflexes
- Impaired coordination
- Impaired balance
- Dizziness
- Muscle Weakness
Coma

In animal models, the oral LD₅₀ of chlordiazepoxide is 537 mg/kg.

Read more at Wikipedia.org

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Heat exhaustion and heatstroke: what you should know
From American Family Physician, 6/1/05

What is heat exhaustion?

Heat exhaustion happens when your body gets too hot. It can be caused by exercise or hot weather. You may feel weak, dizzy, or worried. You also may have a headache or a fast heartbeat. You may get dehydrated and have very little urine.

What should I do if I think I have heat exhaustion?

If you think you may have heat exhaustion, get out of the heat quickly. Rest in a cool, shady place and drink plenty of water or other fluids. Do NOT drink alcohol. Alcohol can make heat exhaustion worse. If you do not feel better within 30 minutes, you should see your doctor. If heat exhaustion is not treated, you can get heatstroke.

What is heatstroke?

Heatstroke is much more serious than heat exhaustion and can kill you. People with heatstroke may seem confused. They may have seizures or go into a coma. Most people with heatstroke also have a fever. Heatstroke can happen when your body gets too hot, or it can happen after heat exhaustion.

What should I do if I think someone has heatstroke?

If you think someone might have heatstroke, you should take him or her to a cool, shady place quickly, and call a doctor. Removing the person's unnecessary clothing and bathing or spraying the person's skin with cool water can help cool him or her down. Try to fan warm air over the person while wetting the skin with lukewarm water. The evaporation of the water will speed cooling (see the figure below).

[FIGURE OMITTED]

How can I keep from getting heat exhaustion and heatstroke?

Do not exercise outside when it is hot and humid. If you have traveled to a place that is hotter than where you live, do not exercise for at least a week. In hot weather, wear cool, light clothing and drink plenty of nonalcoholic fluids. If a heat wave happens, stay in an air-conditioned place. Get medical help immediately if you think you might have heat exhaustion or heatstroke.

How do medicines affect heatstroke?

Some medicines can put you in danger of heatstroke. Tell your doctor what medications you are taking. Some medicines that may affect heatstroke are:

* Allergy medicines (antihistamines)

* Cough and cold medicines (anticholinergics)

* Blood pressure and heart medicines

Alpha andrenergics such as midodrine (one brand: ProAmatine) or pseudoephedrine (one brand: Sudafed)

Beta blockers

Calcium channel blockers

* Diet pills (amphetamines)

* Irritable bladder and irritable bowel medicines (anticholinergics)

* Laxatives

* Mental health medicines

Benzodiazepines such as clonazepam (one brand: Klonopin), diazepam (one brand: Valium), chlordiazepoxide (one brand: Librium)

Neuroleptics

Tricyclic antidepressants

* Seizure medicines (anticonvulsants)

* Thyroid pills

* Water pills

Your doctor can tell you if your medicine puts you in danger of heatstroke.

What should I do after having heat exhaustion or heatstroke?

Having heat exhaustion or heatstroke makes you more vulnerable to hot conditions for about a week afterwards. Be especially careful not to exercise too hard, and avoid hot weather. Ask your doctor to tell you when it is safe to return to your normal activities.

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