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Overview: Chlordiazepoxide/amitriptyline is used to treat depression in people who also have anxiety. It affects natural chemicals in the brain, such as serotonin, and norepinephrine. The most common side effects include drowsiness, dizziness, and blurred vision. Before taking chlordiazepoxide/amitriptyline, tell your healthcare provider about any health conditions you have or medicines you are taking.

Uses

What is chlordiazepoxide/amitriptyline used for?

Chlordiazepoxide/amitriptyline is commonly used to treat depression in people who also have anxiety.

Chlordiazepoxide/amitriptyline may also be used for other conditions as determined by your healthcare provider.

How does chlordiazepoxide/amitriptyline work (mechanism of action)?

Chlordiazepoxide produces a calming effect on the brain and nerves, which helps to reduce anxiety symptoms and promote relaxation.

Amitriptyline is an antidepressant that belongs to a group of medicines called tricyclic antidepressants (TCAs). It works by increasing the amount of natural chemicals called norepinephrine and serotonin in the brain.

How is chlordiazepoxide/amitriptyline supplied (dosage forms)?

Brands and other names

  • Limbitrol
  • Limbitrol DS

Dosage forms and strengths

  • 5 mg/12.5 mg oral tablets
  • 10 mg/25 mg oral tablets

How should I store chlordiazepoxide/amitriptyline?

Chlordiazepoxide/amitriptyline should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place, in a tight, light-resistant container.

Side Effects

What are the most common side effects of chlordiazepoxide/amitriptyline?

The most common side effects of chlordiazepoxide/amitriptyline are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Drowsiness
  • Dizziness
  • Blurred vision
  • Constipation
  • Dry mouth
  • Bloating

There may be other side effects of chlordiazepoxide/amitriptyline that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of chlordiazepoxide/amitriptyline?

While less common, the most serious side effects of chlordiazepoxide/amitriptyline are described below, along with what to do if they happen.

Severe Allergic Reactions. Chlordiazepoxide/amitriptyline may cause allergic reactions, which can be serious. Stop taking chlordiazepoxide/amitriptyline and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Suicidal Thoughts or Actions. Chlordiazepoxide/amitriptyline or other antidepressants may increase the risk of suicidal thoughts or actions in a small number of children, teenagers, or young adults in the first few months of taking the medicine or when the dose is changed. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your healthcare provider right away if you have any of the following symptoms.

  • New or increased thoughts of suicide or death
  • Suicide attempt
  • New or increased feelings of anxiety, depression, or other unusual changes in your mood or behavior

Risk of Misuse and Addiction. Misusing chlordiazepoxide/amitriptyline can lead to serious side effects like coma or death. Misuse means taking a medicine in a way other than how it was prescribed. Take chlordiazepoxide/amitriptyline exactly as prescribed. Tell your healthcare provider if you feel that chlordiazepoxide/amitriptyline is not working. Call your healthcare provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Sudden confusion or feeling disoriented
  • Feeling paranoid
  • Suicidal thoughts or actions
  • Seizures
  • Trouble breathing

Dependence and Withdrawal Reactions. Chlordiazepoxide/amitriptyline can cause physical dependence, which means your body relies on the medicine to function properly. If you stop chlordiazepoxide/amitriptyline suddenly, it could lead to withdrawal symptoms, which may be life-threatening. Do not stop taking chlordiazepoxide/amitriptyline without talking with your healthcare provider. Your healthcare provider can tell you how to stop chlordiazepoxide/amitriptyline to reduce the risk of withdrawal reactions. Call your healthcare provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Unusual movements, responses, or expressions
  • Seizures
  • Sudden and severe mental or nervous system changes
  • Seeing or hearing things that others do not see or hear, also called hallucinations
  • An extreme increase in activity or talking
  • Losing touch with reality

Some people may have the following symptoms of a withdrawal reaction that can last for several weeks to more than 12 months.

  • Anxiety
  • Trouble remembering, learning, or concentrating
  • Depression
  • Problems sleeping
  • Feeling like insects are crawling under the skin
  • Weakness
  • Shaking
  • Muscle twitching
  • Burning or prickling feeling in the hands, arms, legs, or feet
  • Ringing in the ears

Extremely Elevated Mood (Mania). People with bipolar disorder can have severe high and low moods. The first symptom of bipolar disorder may be depression. People with bipolar disorder who take an antidepressant, such as chlordiazepoxide/amitriptyline, may have a higher risk of having mania or a manic episode. Call your doctor right away if you have any of the following symptoms of a manic episode.

  • Very increased energy
  • Significant trouble sleeping
  • Racing, fast-paced thoughts
  • Reckless behavior
  • Unusually grand ideas
  • Excessive happiness or irritability
  • Talking faster or more than usual

Glaucoma. Chlordiazepoxide/amitriptyline may increase pressure inside the eye and cause or worsen narrow-angle glaucoma in some people. This can lead to blindness. Ask your healthcare provider if you should have your eyes examined to see if you are at risk. Tell your healthcare provider right away if you have any of the following symptoms.

  • Loss of vision
  • Eye pain or redness
  • Severe headache or vomiting
  • Seeing bright, colorful circles around lights (vision halos)

Heart Rhythm Changes. Chlordiazepoxide/amitriptyline may cause heart rhythm problems that can lead to an irregular heartbeat and fainting. In rare cases, this may cause the heart to suddenly stop beating (cardiac arrest). Some people have a higher risk of this, including people with existing heart disease or who take other medicines that affect the heart. Get emergency help if you have any of the following signs of heart rhythm changes.

  • Chest pain
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat

Blood Disorders. Chlordiazepoxide/amitriptyline can cause blood disorders, such as agranulocytosis, eosinophilia, and low platelet levels (thrombocytopenia). Get help right away if you have any of the following symptoms of blood disorders.

  • Fever
  • Shortness of breath
  • Pale or yellowish skin
  • Easy bruising or bleeding
  • Frequent infection
  • Unusual weakness or tiredness
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Headache
  • Fast or abnormal heartbeat

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking chlordiazepoxide/amitriptyline. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Warnings & Precautions

Who should not use chlordiazepoxide/amitriptyline?

Allergies to Ingredients. People who are allergic to any of the following should not take chlordiazepoxide/amitriptyline.

  • Chlordiazepoxide
  • Amitriptyline
  • Limbitrol
  • Limbitrol DS
  • Any other medicine known as a benzodiazepine
  • Any other medicine known as a tricyclic antidepressant
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific chlordiazepoxide/amitriptyline products they stock.

Drug Interactions. Chlordiazepoxide/amitriptyline should not be taken while you are using certain other medicines. Before taking chlordiazepoxide/amitriptyline, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Heart Attack. Chlordiazepoxide/amitriptyline should not be taken if you’ve just had a heart attack.

What should I know about chlordiazepoxide/amitriptyline before using it?

Do not take chlordiazepoxide/amitriptyline unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share chlordiazepoxide/amitriptyline with other people, even if they have the same condition as you. It may harm them.

Keep chlordiazepoxide/amitriptyline out of the reach of children. Chlordiazepoxide/amitriptyline is a controlled substance because it can be misused or lead to dependence. Store chlordiazepoxide/amitriptyline in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

People who are 65 and older can be at greater risk for some side effects of chlordiazepoxide/amitriptyline. Talk to your healthcare provider about your risks if you are in this age group.

Chlordiazepoxide/amitriptyline can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how chlordiazepoxide/amitriptyline affects you.

Chlordiazepoxide/amitriptyline can make your skin more sensitive to light from the sun, sunlamps, and tanning beds. This is called photosensitivity. Exposure to this light can cause severe sunburns, blisters, and swelling. If you need to be in sunlight, wear sunscreen, a hat, and clothing that covers your skin.

Talk with your healthcare provider if you get electroconvulsive therapy (ECT). Chlordiazepoxide/amitriptyline may increase the risk of problems from such therapy.

What should I tell my healthcare provider before using chlordiazepoxide/amitriptyline?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if chlordiazepoxide/amitriptyline is right for you.

In particular, make sure that you discuss any of the following.

Substance Use Disorder. Chlordiazepoxide/amitriptyline is a controlled substance and may be misused or lead to dependence. Tell your healthcare provider if you have a history of a drug or alcohol use disorder.

Brugada Syndrome. Chlordiazepoxide/amitriptyline should not be taken by people who have or are suspected to have this genetic heart rhythm disorder. For example, you should not take chlordiazepoxide/amitriptyline if you have a history of unexplained fainting or a family history of sudden unexplained death before age 45.

Other Current and Past Health Conditions. Tell your healthcare provider if you have any of the following. 

  • High blood pressure
  • Heart, kidney, or liver problems
  • Seizures or convulsions
  • Bipolar disorder, mania, or schizophrenia
  • Suicidal thoughts or attempts
  • Family history of suicide, bipolar disorder, or depression
  • Glaucoma
  • Inability to empty your bladder
  • High thyroid hormone level
  • History of stroke
  • Diabetes 
  • Planned surgery

Pregnancy. It is not known if or how chlordiazepoxide/amitriptyline could affect pregnancy or harm an unborn baby. Using chlordiazepoxide/amitriptyline during the later stages of pregnancy can cause withdrawal and the following symptoms, in newborns.

  • Breathing problems
  • Sluggishness
  • Low muscle tone
  • Jitteriness
  • Fussiness or irritability
  • Restlessness
  • Shaking
  • Excessive crying
  • Feeding problems

Tell your healthcare provider if you are or plan to become pregnant. If you become pregnant while using chlordiazepoxide/amitriptyline, talk to your healthcare provider about registering with the National Pregnancy Registry for Psychiatric Medications. This registry collects information about the safety of psychiatric medicines during pregnancy. You can register by calling 866-961-2388 or online at https://womansmentalhealth.org/pregnancyregistry/.

Breastfeeding. It is not known if chlordiazepoxide/amitriptyline passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take chlordiazepoxide/amitriptyline while breastfeeding.

Interactions

Does chlordiazepoxide/amitriptyline interact with foods or drinks?

There are no known interactions between chlordiazepoxide/amitriptyline and foods or drinks.

Do not drink alcohol while taking chlordiazepoxide/amitriptyline. The risk of serious problems such as severe dizziness, sleepiness, and trouble breathing may be increased if you drink alcohol while taking chlordiazepoxide/amitriptyline.

Does chlordiazepoxide/amitriptyline interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using chlordiazepoxide/amitriptyline.

  • A benzodiazepine, such as clonazepam (Klonopin), diazepam (Valium and others), or lorazepam (Ativan and others), which is a medicine used for anxiety, muscle spasms, or seizures
  • A tricyclic antidepressant, such as nortriptyline or protriptyline, even if it is not used for depression
  • A monoamine oxidase inhibitor (MAOI) within the past 2 weeks, which is a medicine usually used for depression or Parkinson’s disease
  • An opioid, such as oxycodone, morphine, codeine, or fentanyl, which is a medicine used for certain types of pain
  • Topiramate, which is a medicine that is commonly used for migraine or seizures
  • A selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI), which are medicines commonly used for anxiety and depression
  • An antipsychotic, which is a medicine for certain mental health conditions
  • Clonidine (Catapres-TTS and others), which is a medicine used for high blood pressure or attention deficit hyperactivity disorder (ADHD)
  • Certain medicines used to manage irregular heart rhythms, such as flecainide, propafenone, or quinidine
  • A thyroid medicine, such as levothyroxine, which is used to raise thyroid hormone levels
  • Any other medicine that causes dizziness and sleepiness (such as prescription pain medicines, sleep medicines, and medicines for anxiety)
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
  • Cimetidine, which is a medicine that is commonly used for indigestion or stomach ulcers

Many other medicines may alter the blood levels of chlordiazepoxide/amitriptyline. Tell your healthcare provider about all medicines that you take or have recently taken.

Do not take additional medicines that contain chlordiazepoxide or amitriptyline, like plain chlordiazepoxide capsules or plain amitriptyline tablets or perphenazine/amitriptyline tablets.

This may not be a complete list of medicines that can interact with chlordiazepoxide/amitriptyline. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much chlordiazepoxide/amitriptyline?

If you or someone else has used too much chlordiazepoxide/amitriptyline, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of chlordiazepoxide/amitriptyline?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.