To reduce stomach upset, take this medicine immediately after meals or with food unless your doctor has told you to take it on an empty stomach.

Sometimes this medicine must be taken for several weeks before you begin to feel better. Your doctor should check your progress at regular visits.

Take this medicine only as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer period of time than your doctor ordered. If too much is taken, it may increase unwanted effects or become habit-forming (causing mental or physical dependence).

If you think this medicine is not working properly after you have taken it for a few weeks, do not increase the dose. Instead, check with your doctor.

Dosing

The dose of chlordiazepoxide and amitriptyline combination will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of chlordiazepoxide and amitriptyline combination. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking chlordiazepoxide and amitriptyline combination.

• For oral dosage forms (tablets):
  • Adults and adolescents: To start, 5 milligrams of chlordiazepoxide and 12.5 milligrams of amitriptyline or 10 milligrams of chlordiazepoxide and 25 milligrams of amitriptyline, taken three or four times a day. The doctor may adjust your dose if needed. However, the dose is usually not greater than 10 milligrams of chlordiazepoxide and 25 milligrams of amitriptyline taken six times a day.
  • Children up to 12 years of age: Dose must be determined by the doctor.

Missed dose

If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children. Overdose of this medicine is very dangerous in young children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For chlordiazepoxide and amitriptyline combination, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to chlordiazepoxide (e.g., Librium) or other benzodiazepines (such as alprazolam [e.g., Xanax], bromazepam [e.g., Lectopam], clonazepam [e.g., Klonopin], clorazepate [e.g., Tranxene], diazepam [e.g., Valium], estazolam [e.g., ProSom], flurazepam [e.g., Dalmane], halazepam [e.g., Paxipam], ketazolam [e.g., Loftran], lorazepam [e.g., Ativan], midazolam [e.g., Versed], nitrazepam [e.g., Mogadon], oxazepam [e.g., Serax], prazepam [e.g., Centrax], quazepam [e.g., Doral], temazepam [e.g., Restoril], triazolam [e.g., Halcion]) or to amitriptyline (e.g., Elavil) or other tricyclic antidepressants (such as amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]).

Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy

• Chlordiazepoxide: Chlordiazepoxide has been reported to increase the chance of birth defects when used during the first 3 months of pregnancy.In addition, overuse of chlordiazepoxide during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects in the baby after birth.Use of chlordiazepoxide during pregnancy, especially during the last weeks, may cause drowsiness, slow heartbeat, shortness of breath, or troubled breathing in the newborn baby. Chlordiazepoxide given just before or during labor may cause weakness in the newborn baby.
• Amitriptyline: Studies with amitriptyline have not been done in pregnant women. However, studies in animals have shown amitriptyline to cause birth defects when used in doses many times the human dose. Also, there have been reports of newborns suffering from muscle spasms and heart, breathing, and urinary problems when their mothers had taken tricyclic antidepressants (such as amitriptyline) immediately before delivery.

Breast-feeding Chlordiazepoxide may pass into the breast milk and cause drowsiness, slow heartbeat, shortness of breath, or troubled breathing in babies of mothers taking this medicine. Although amitriptyline has also been found in breast milk, it has not been reported to cause problems in nursing babies.

Children Children may be especially sensitive to the effects of chlordiazepoxide and amitriptyline combination. This may increase the chance of side effects during treatment.

Older adults Elderly people are especially sensitive to the effects of chlordiazepoxide and amitriptyline combination. This may increase the chance of side effects during treatment.

Other medicines Although certain medicines should not be used together at all, in other cases 2 different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking chlordiazepoxide and amitriptyline combination, it is especially important that your health care professional know if you are taking any of the following:

• Alcohol or
• Central nervous system (CNS) depressants (medicines that cause drowsiness) Using these medicines with chlordiazepoxide and amitriptyline combination may increase the CNS depressant effects

• Amphetamines or
• Appetite suppressants (diet pills) or
• Medicine for asthma or other breathing problems or
• Medicine for colds, sinus problems, or hay fever or other allergies (including nose drops or sprays) Using these medicines with chlordiazepoxide and amitriptyline combination may increase the risk of serious effects on your heart

• Antacids Taking these medicines with chlordiazepoxide and amitriptyline combination may delay the combination medicine's effects

• Antihypertensives (high blood pressure medicine) Taking these medicines with chlordiazepoxide and amitriptyline combination may increase the chance of low blood pressure (hypotension)

• Antithyroid agents (medicine for overactive thyroid) or
• Cimetidine (e.g., Tagamet) Taking these medicines with chlordiazepoxide and amitriptyline combination may increase the chance of serious side effects

• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) Taking chlordiazepoxide and amitriptyline combination while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may cause sudden very high body temperature, extremely high blood pressure, and severe convulsions; however, sometimes certain of these medicines may be used with this combination medicine under close supervision by your doctor

• Alcohol abuse (or history of) or
• Drug abuse or dependence (or history of) Dependence on this medicine may develop

• Bipolar disorder (manic-depressive illness) or
• Blood problems or
• Difficulty in urinating or
• Emphysema, asthma, bronchitis, or other chronic lung disease or
• Enlarged prostate or
• Glaucoma or increased eye pressure or
• Heart disease or
• Mental illness (severe) or
• Myasthenia gravis or
• Porphyria Chlordiazepoxide and amitriptyline combination may make the condition worse

• Epilepsy or history of seizures The risk of seizures may be increased

• Hyperactivity Chlordiazepoxide and amitriptyline combination may cause unexpected effects

• Kidney disease or
• Liver disease Higher blood levels of chlordiazepoxide and amitriptyline may occur, increasing the chance of side effects

• Overactive thyroid or
• Stomach or intestinal problems Use of this combination medicine may result in more serious problems