From the FDA Drug Label
DOSAGE AND ADMINISTRATION Recommended Dosage Because of the varied individual responses to tranquilizers and anticholinergics, the optimum dosage of Chlordiazepoxide Hydrochloride and Clidinium Bromide Capsules vary with the diagnosis and response of the individual patient. The dosage, therefore, should be individualized for maximum beneficial effects The usual maintenance dose is 1 or 2 capsules, 3 or 4 times a day administered before meals and at bedtime. INDICATIONS AND USAGE Chlordiazepoxide Hydrochloride and Clidinium Bromide Capsules are indicated to control emotional and somatic factors in gastrointestinal disorders. Chlordiazepoxide Hydrochloride and Clidinium Bromide Capsules may also be used as adjunctive therapy in the treatment of peptic ulcer and in the treatment of the irritable bowel syndrome (irritable colon, spastic colon, mucous colitis) and acute enterocolitis.
The recommended use of Clidinium is to control emotional and somatic factors in gastrointestinal disorders, including:
- Peptic ulcer
- Irritable bowel syndrome (irritable colon, spastic colon, mucous colitis)
- Acute enterocolitis The recommended dosage is 1 or 2 capsules, 3 or 4 times a day, administered before meals and at bedtime 1. The dosage should be individualized for maximum beneficial effects 1.
From the Research
Clidinium is recommended at a dosage of 2.5 to 5 mg three to four times daily before meals and at bedtime for treating gastrointestinal disorders, particularly those characterized by excessive motility and spasms, as it has been shown to be effective in reducing symptoms of irritable bowel syndrome, peptic ulcer disease, and functional dyspepsia 2.
Key Points to Consider
- The medication works by blocking acetylcholine receptors, which reduces smooth muscle contractions in the gastrointestinal tract, decreases gastric acid secretion, and slows intestinal motility.
- Clidinium is often combined with chlordiazepoxide (as Librax) for added anxiety relief, which can be beneficial since stress often exacerbates gastrointestinal symptoms.
- Patients should take the medication 30-60 minutes before meals for optimal effect.
- Treatment duration typically ranges from a few weeks to several months, depending on symptom response and the underlying condition.
- Side effects may include dry mouth, blurred vision, constipation, and urinary retention due to its anticholinergic properties.
- Clidinium should be used cautiously in elderly patients and is contraindicated in those with glaucoma, prostatic hypertrophy, or obstructive gastrointestinal disorders.
Evidence-Based Recommendations
- A systematic review of 56 studies (3725 patients) found that antispasmodics, including clidinium, are effective for the treatment of irritable bowel syndrome, with a significant benefit for improvement of abdominal pain, global assessment, and symptom score 2.
- Another study found that clidinium reduces the prolonged postprandial colonic spike and motor response in patients with irritable bowel syndrome, indicating its effectiveness in treating gastrointestinal symptoms 3.
- However, it is essential to note that the use of central neuromodulators, such as clidinium, may be limited by concerns about side effects, and education is needed to improve gastroenterologists' prescribing behavior 4.