MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Anxiety

Drug Safety Update

 March 2020 Benzodiazepines and opioids: reminder of the risk of potentially fatal respiratory depression

NICE Guidance (see also drug-specific links below)

  CG113 Generalised anxiety disorder and panic disorder in adults: management, January 2011

 Local Guidelines

Management of Acute Alcohol Withdrawal, Protocol  MTW Management of Acute Alcohol Withdrawal Protocol (see also below under chlordiazepoxide)

For more information on prescribing for patients with a variety of anxiety disorders please refer to  Kent and Medway NHS and Social Care Partnership Trust (KMPT) Formulary

Pack Price
100 tablet
1000 tablet
28 tablet £0.33
500 tablet
Pack Price
1000 tablet
28 tablet £0.37
Pack Price
100 tablet
28 tablet £0.43
500 tablet
Pack Price
100 ml £42.71
Pack Price
5 tube £5.65
Pack Price
5 tube £5.85
Pack Price
5 tube £7.35
Pack Price
10 ampoule £5.50
Pack Price
10 ampoule £9.05
Pack Price
100 tablet
1000 tablet
28 tablet £3.83
30 tablet
50 tablet
Pack Price
28 tablet £9.14
30 tablet
Pack Price
10 ampoule £3.54

Alcohol withdrawal

Chloridazepoxide is the benzodiazepine of choice to control symtoms of acute alcohol withdrawal, such as agitation, tremor, anxiety, autonomic overactivity and seizures. The drug prevents an established alcohol withdrawal syndrome progressing further to the pre-delirium tremens or delirium tremens (DT's) state.

All patients suspected of going into acute alcohol withdrawal should have the following investigations:

  • U&E's
  • Mg & PO4
  • LFT's
  • blood glucose
  • FBC
  • clotting screen
  • folate/B12

Symptoms should be assessed immediately using the alcohol withdrawal assessment scoring guidelines, (CIWA-Ar). This should be repeated every 2-4 hours as appropriate.

If score >35 Contact ITU
If score >15 Treat with scheduled chlordiazepoxide dosing regime to be written on drug chart as suggested
If score 8-14 Treat with as required chlordiazepoxide 20-30mg and monitor 2 hourly for day 0-2 and 4 hourly for days 3-4
If score <8 Monitor 4 hourly but not for treatment

Chlordiazepoxide reducing regime

Time Day 1
(mg)
Day 2 Day 3 Day 4
08:00 30 20 10 10
12:00 30 20 10  
16:00 30 20 10  
20:00 30 30 20 10

Chlordiazepoxide has an abuse and dependence potential - a maximum of 14 days treatment is advised.

This regime is intended for use in hospital only. Chlordiazepoxide is not supplied on discharge and must not be prescribed if the patient is likely to continue drinking alcohol.

Vitamin B supplements may also be required - see the full alcohol withdrawal management protocol (link above).

Pack Price
100 capsule £11.50
28 capsule
500 capsule
Pack Price
100 capsule £17.80
28 capsule
500 capsule