chlordiazepoxide (Librium)

Chlordiazepoxide is a psychotropic agent that is used to manage symptoms associated with anxiety disorders. It is a long acting benzodiazepine that is available for oral administration. Examples of other members of the benzodiazepine include:

• diazepam (Valium)
• clonazepam (Klonopin)
• lorazepam (Ativan)
• flurazepam (Dalmane)

Chlordiazepoxide has anti-anxiety, sedative, appetite-stimulating, and weak pain relieving properties. The exact mechanism of how chlordiazepoxide provides therapeutic benefits is not yet understood. However, current understanding of benzodiazepines indicates that they enhance or increase the activity of GABA, an inhibitory neurotransmitter, a chemical that cells in the brain use to suppress the activity of other cells.

Chlordiazepoxide was initially approved by the US FDA in 1960. The injectable formulation of chlordiazepoxide is no longer available in the US.

What brand names are available for chlordiazepoxide?

Librium

Is chlordiazepoxide available as a generic drug?

Yes

Do I need a prescription for chlordiazepoxide?

Yes

Reported side effects include:

• Drowsiness
• Impaired muscle control (ataxia)
• Confusion
• Dizziness
• Skin problems
• Edema
• Minor menstrual irregularities
• Nausea
• Constipation
• Movement disorders
• Decreased desire for sexual activity (decreased libido).

Serious side effects that have been reported are:

• Blood disorders
• Jaundice
• Liver dysfunction

Adults

• For the treatment of mild to moderate anxiety disorders or symptoms: 5 to 10 mg by mouth 3-4 times daily.
• For the treatment of severe anxiety disorders or symptoms: 20 to 25 mg by mouth 3-4 times daily.
• For the management of preoperative apprehension and anxiety: 5 to 10 mg by mouth 3-4 times daily on days preceding surgery.

Dosing: Pediatrics

• For the treatment of anxiety symptoms in children = 6 years to adolescents the usual daily recommended dose is 5 mg 2-4 times daily.
• Dosage may be increased to 10 mg per day given in 2-3 divided doses if necessary.
• Chlordiazepoxide is not recommended for use in children below the age of 6 years.

Dosing: Geriatric patients

• The usual recommended dose is 5 mg 2 to 4 times daily.

Chlordiazepoxide is metabolized or broken down by a group of enzymes in the liver known as the cytochrome P450 3A4 enzymes. Drugs which inhibit these enzymes reduce the metabolism of chlordiazepoxide and have the potential for causing side effects.

Examples of CYP3A4 inhibitors are:

• amiodarone (Cordarone)
• Anti-retroviral protease inhibitors (some types of anti-HIV medications)
• fluconazole (Diflucan)
• itraconazole (Sporanox)
• ketoconazole (Nizoral)
• voriconazole (Vfend)
• miconazole (Monistat)
• cimetidine (Tagamet)
• clarithromycin (Biaxin)

Additionally, inducers of the CYP 3A4 enzymes may increase the activity of these enzymes and cause blood levels of chlordiazepoxide to decrease.

Examples of CYP 3A4 inducers are:

• carbamazepine (Tegretol)
• rifampin (Rimactane)
• phenytoin (Dilantin)
• St. John's Wort

Chlordiazepoxide has depressant effects on the central nervous system. Medications which have similar activity may increase the risk for drowsiness, respiratory depression, and other CNS depressant effects. Therefore, co-administration with alcohol, kava-kava, other benzodiazepines, and opiates should generally be avoided.

Chlordiazepoxide is classified as FDA pregnancy risk category D. Due to the risk of potential harm to the fetus, use of chlordiazepoxide during pregnancy is not recommended.

This medication is thought to be excreted into breast milk. Due to the lack of conclusive safety data, use in nursing mothers is not recommended.

What preparations of chlordiazepoxide are available?

Oral capsules: 5, 10, and 25 mg

How should I keep chlordiazepoxide stored?

Capsules should be stored at room temperature, between 20 C to 25 C (68 F to 77 F).