Q: My father, 55 years old, was prescribed Amexide for 7 years. Towards the end of the seven years he was having half a tablet once daily. But since 2 years, he has been having Restyl 0.25 mg once daily. However, he has stopped using the same and has been experiencing withdrawal symptoms. He wants to restart Amexide. Is it advisable? He has had a bypass surgery when the medicine was changed.

A:Amixide (not Amexide) is the brand name of a combination product that contains two drugs: chlordiazepoxide and amitriptyline. Chlordiazepoxide alone is used in the treatment of anxiety for short duration. Prolonged use leads to addiction and dependence and withdrawal symptoms. Amitriptyline alone is indicated in the treatment of depression and results in withdrawal symptoms. Amixide is an irrational combination, which is not sold in any advanced country. A patient who was prescribed an irrational combination product for 7 years is bound to have adverse effects when an attempt is made to wean him away. The patient can be given chlordiazepoxide alone (sold as Equilibrium) 10 mg at bedtime for about 10 days, then reduce the dose to 5 mg for another 10 days and ultimately total withdrawal. Hopefully he will respond to this therapy. If necessary the gradual withdrawal can be done over 4-6 weeks. Restyl contains alprazolam, again an anti-anxiety agent but since the patient is addicted to chlordiazepoxide, it is better to taper off the dose of this agent rather than add another drug.