Although not a significant drug of abuse itself, the benzodiazepine in Limbitrol can be abused. Therefore, Limbitrol is a controlled substance.
What is Limbitrol?
Limbitrol is a medication that combines two drugs: amitriptyline and chlordiazepoxide. Amitriptyline is a tricyclic antidepressant medication, and chlordiazepoxide is a benzodiazepine.
Limbitrol is primarily designed to address depressive symptoms that occur in conjunction with anxiety. It can be used to treat other issues, such as certain types of pain, or it can be used as a mild sedative.
Amitriptyline is an older tricyclic antidepressant medication. It works by increasing the availability of different neurotransmitters in the brain, including dopamine, serotonin, and norepinephrine.
It was approved for the treatment of depression in the 1980s by the U.S. Food and Drug Administration (FDA). The medications in its class (tricyclics) have largely been replaced by other antidepressant medications that produce fewer side effects.
It was once marketed under the brand name Elavil, although now amitriptyline alone is most often available in generic forms.
Amitriptyline is not a controlled substance. It is considered to have very little potential for abuse as it does not produce significant psychoactive effects such as euphoria.
It may still be used to treat different types of pain, such as headaches. Sometimes, it may be used in conjunction with other medications in the treatment of attention-deficit hyperactivity disorder (ADHD).
Chlordiazepoxide is a benzodiazepine, often marketed under the brand name Librium. Benzodiazepines are designed to address anxiety disorders and seizures and produce sedation. Librium can also be used as a withdrawal management medication for alcohol, other benzodiazepines, and other substances of abuse.
Chlordiazepoxide is a controlled substance classified in the C IV (Schedule IV) category by the U.S. Drug Enforcement Administration (DEA). Long-term use of this medication may produce physical dependence. Benzodiazepines are widely known as potential drugs of abuse.
Chlordiazepoxide works on a different set of neurotransmitters than amitriptyline. It affects the availability of gamma-Aminobutyric acid, the major inhibitory neurotransmitter in the brain. This medication decreases the firing rates of other neurons in the brain, leading to reduced anxiety and increased sedation. It can be used to control seizure activity in the brain.
Is Limbitrol a Controlled Substance?
Yes, any medication that contains chlordiazepoxide is classified in the C IV category of controlled substances. This also indicates that Limbitrol does have the potential to be abused.
There appear to be relatively few studies that report rates of abuse for Limbitrol. Instead, some isolated case studies suggest that the drug is occasionally abused.
Because Limbitrol contains two medications, you run the risk of experiencing side effects from either medication. The most common side effects associated with its use include the following:
- Blurred vision
- Dry mouth
- Constipation or bloating
- Difficulty with urination
- Weight gain
Some Rarer But More Serious Side Effects May Occur that Require Immediate Medical Attention. They Are:
- Allergic reactions
- Suicidal thoughts, especially in adolescents
- Memory loss for events that occur when using the medication
Although there is a potential to develop physical dependence on amitriptyline, it’s more likely that people develop dependence on chlordiazepoxide with long-term use. Even use of the drug for medical reasons over an extended period may result in a mild syndrome of physical dependence.
Benzodiazepines are not designed to be long-term solutions for anxiety and depression, although they are often prescribed over the long run for these issues. Tolerance to the drug develops rapidly, and more of the medication is needed to experience its effect. This can lead to a potentially dangerous situation and the development of physical dependence.
Instead, benzodiazepines like chlordiazepoxide are best used for the treatment of these issues over the short term. Users should be developing other coping strategies in therapy and getting other types of support to address anxiety, other mood issues, and insomnia.
What Does Withdrawal from Limbitrol Look Like?
If you develop withdrawal symptoms when you stop taking Limbitrol, they can follow a variable course. Generally, they occur according to the following pattern:
- Symptoms appear within two to four days of stopping use of the drug.
- Symptoms typically peak within three to five days of stopping use.
- After the symptoms peak, less intense symptoms may continue for 1-2 weeks.
- Most often, the symptoms will have significantly resolved after 2-3 weeks
The types of symptoms that can occur can be quite variable. They will often consist of insomnia, a return of anxiety (rebound anxiety), nausea, vomiting, stomach cramps, loss of appetite, tremors, fever, chills, sweating, mood swings, and cravings. Most people do not experience all of these symptoms, but most experience insomnia, anxiety, and flu-like symptoms.
There is potential to develop seizures as part of the withdrawal syndrome. Seizures can be potentially fatal, so you should stop using the drug only under the supervision of a physician.
Overdosing on Limbitrol can be fatal because of the presence of chlordiazepoxide in the drug. Overdose may produce significant lethargy, problems with coordination, slurred speech, mental confusion, and potentially a coma.
A decreased breathing rate and a decreased heart rate are also very likely during an overdose. These could potentially be fatal.
If you suspect that you or someone else has overdosed on Limbitrol, contact emergency medical services immediately (call 911). Do not take or administer liquid, food, or medication unless you have been trained to do so.
Signs of Abuse
If you are diagnosed with a substance use disorder as a result of Limbitrol abuse, you would most likely be diagnosed with a sedative, hypnotic, or anxiolytic use disorder.
The formal symptoms associated with this disorder can only be recognized and diagnosed by a licensed mental health care clinician. Certain signs to look for include:
- Frequently using Limbitrol for reasons other than its prescribed purpose
- Experiencing significant distress or problems with normal functioning as a result of Limbitrol use
- Frequently experiencing problems with controlling how often you use the drug, the amount of the drug you use, or in other situations when you use Limbitrol
- Continuing to use the medication despite negative ramifications
- Frequently using up your prescription before its renewal date or attempting to get multiple prescriptions for the drug
- Often using the drug in conjunction with other potential drugs of abuse, such as alcohol, prescription pain medications, or other benzodiazepines
- Developing significant tolerance to Limbitrol
- The development of physical dependence on Limbitrol in conjunction with the other signs and symptoms of abuse
Treatment for Abuse
Because Limbitrol contains chlordiazepoxide, the first step in treating abuse of the drug is a physician-assisted medical detox (withdrawal management) program. You would likely be admitted to the program on an inpatient basis, although outpatient medical detox could be possible in some instances.
Detox involves a tapering schedule of chlordiazepoxide or another benzodiazepine to avoid seizures and other withdrawal symptoms. During this program, you begin treatment for your substance abuse, including therapy, group support, and other interventions. Treatment for any addiction should be long-term, allowing enough time to effectively address the underlying issues that led to substance abuse.