What happens if I overdose Disarim?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately. Symptoms may include confusion; clumsiness; deep sleep; diminished reflexes; drowsiness; impaired coordination; loss of consciousness; slow reflexes.
Proper storage of Disarim injection:
Store the powder at room temperature (59 to 77 degrees F) (15 to 25 degrees C). Store away from heat and light. Do not store in the bathroom. Store the special liquid used for mixing in the refrigerator (36 to 46 degrees F; 2 to 8 degrees C). Do not freeze. Prepare solution immediately before using. Throw away any unused solution. Disarim injection may not be prepared and stored for later use. Keep Disarim injection, as well as needles and syringes, out of the reach of children and away from pets.
Overdose of Disarim in details
Manifestations of Disarim hydrochloride overdosage include somnolence, confusion, coma and diminished reflexes. Respiration, pulse and blood pressure should be monitored, as in all cases of drug overdosage, although, in general, these effects have been minimal following Disarim hydrochloride overdosage. General supportive measures should be employed, along with immediate gastric lavage.
Intravenous fluids should be administered and an adequate airway maintained. Hypotension may be combated by the use of Levophed® (norepinephrine) or Aramine (metaraminol). Dialysis is of limited value. There have been occasional reports of excitation in patients following Disarim hydrochloride overdosage; if this occurs barbiturates should not be used. As with the management of intentional overdosage with any drug, it should be borne in mind that multiple agents may have been ingested.
Flumazenil, a specific benzodiazepine-receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for resedation, respiratory depression and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in longterm benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert, including CONTRAINDICATIONS, WARNINGS and PRECAUTIONS, should be consulted prior to use.
What should I avoid while taking Disarim?
Do not drink alcohol while taking Disarim. This medication can increase the effects of alcohol.
Disarim can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, or depression can add to sleepiness caused by Disarim. Tell your doctor if you regularly use any of these medicines, or any other anxiety medications.
Disarim warnings
With great caution use Disarim in patients with heart and chronic respiratory failure, cerebral organic changes (in such cases are advised to avoid parenteral Disarim), with angle-closure glaucoma and predisposition to it, in infants, chronic kidney or liver diseases.
It needed special care when using Disarim, especially at the beginning of treatment, in patients receiving long-term antihypertensive centrally acting agents, beta-blockers, anticoagulants, cardiac glycosides.
If you cancel a therapy the dose should be reduced gradually. With the sudden cancellation of Disarim after prolonged use it may be anxiety, agitation, tremors, convulsions.
With prolonged use at high doses it possible develop an addiction and drug dependence.
Disarim should be removed during the development of paradoxical reactions (severe agitation, anxiety, sleep disorders and hallucinations).
Avoid IA administration.
In the period of treatment avoid alcohol.
What should I discuss with my healthcare provider before taking Disarim?
Do not use this medication if you are allergic to Disarim or to other benzodiazepines, such as alprazolam (Xanax), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).
Before taking Disarim, tell your doctor if you are allergic to any drugs, or if you have:
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glaucoma;
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asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
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porphyria;
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kidney or liver disease;
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a history of depression or suicidal thoughts or behavior; or
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a history of drug or alcohol addiction.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.
Disarim may be habit-forming and should be used only by the person it was prescribed for. Disarim should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.
Disarim can cause birth defects in an unborn baby. Do not use Disarim without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.
Disarim may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
The sedative effects of Disarim may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking Disarim.
Disarim precautions
In elderly and debilitated patients, it is recommended that the dosage be limited to the smallest effective amount to preclude the development of ataxia or oversedation (10 mg or less per day initially, to be increased gradually as needed and tolerated). In general, the concomitant administration of Disarim hydrochloride and other psychotropic agents is not recommended. If such combination therapy seems indicated, careful consideration should be given to the pharmacology of the agents to be employed - particularly when the known potentiating compounds such as MAO inhibitors and phenothiazines are to be used. The usual precautions in treating patients with impaired renal or hepatic function should be observed.
Paradoxical reactions, e.g., excitement, stimulation and acute rage, have been reported in psychiatric patients and in hyperactive aggressive pediatric patients, and should be watched for during Disarim hydrochloride therapy. The usual precautions are indicated when Disarim hydrochloride is used in the treatment of anxiety states where there is any evidence of impending depression; it should be borne in mind that suicidal tendencies may be present and protective measures may be necessary. Although clinical studies have not established a cause and effect relationship, physicians should be aware that variable effects on blood coagulation have been reported very rarely in patients receiving oral anticoagulants and Disarim hydrochloride. In view of isolated reports associating Disarim with exacerbation of porphyria, caution should be exercised in prescribing Disarim to patients suffering from this disease.
Pediatric Use:
Because of the varied response of pediatric patients to CNS-acting drugs, therapy should be initiated with the lowest dose and increased as required. Since clinical experience with Disarim hydrochloride in pediatric patients under 6 years of age is limited, use in this age group is not recommended. Hyperactive aggressive pediatric patients should be monitored for paradoxical reactions to Disarim hydrochloride.
Information for Patients:
To assure the safe and effective use of benzodiazepines, patients should be informed that, since benzodiazepines may produce psychological and physical dependence, it is advisable that they consult with their physician before either increasing the dose or abruptly discontinuing this drug.
What happens if I miss a dose of Disarim?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
References
- DailyMed. "AMITRIPTYLINE HYDROCHLORIDE; CHLORDIAZEPOXIDE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DrugBank. "chlordiazepoxide". http://www.drugbank.ca/drugs/DB00475 (accessed September 17, 2018).
- MeSH. "Hypnotics and Sedatives". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
