View source for Chlordiazepoxide

==General==
*Type: [[Benzodiazepines]]
*Dosage Forms: 5,10, 25mg tab
*Common Trade Names: Librium

==Adult Dosing==
*EtOH withdrawal
**Example taper:
***Day 1: 50mg q6h
***Day 2: 25mg q6h
***Day 3: 25mg q12h
***Day 4: 25mg at night
*** (Rx fifteen 25mg tabs)
**Max 300mg per 24 hours

==Pediatric Dosing==
*N/A

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Category D
*[[Lactation risk categories]]: L4; enters breast milk, not recommended
*Renal Dosing: CrCl < 10 cc/min : 1/2 normal dose
*Hepatic Dosing: No specific guidelines. Use caution as hepatically metabolized

==Contraindications==
*Allergy to class/drug

==Adverse Reactions==
===Serious===
*CNS depression
*Paradoxical agitation
*Drug induced EPS
*Bone marrow suppression, agranulocytosis

===Common===
*Drowsiness

==Pharmacology==
*Time to peak: 0.5-2 h
*Half-life: Parent compound 6-28 h, demoxepam (metabolite) 14-95 h
*Metabolism: Hepatic to desmethyldiazepam (active), desmethylchlordiazepoxide, demoxepam
*Excretion: Urine
*Mechanism of Action: [[Benzodiazepines]]

==See Also==
*[[Alcohol withdrawal]]
*[[EBQ:Outpatient use of benzodiazepines for the treatment of acute alcohol withdrawal]]

==References==
*Lexicomp
*2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi: 10.1111/jgs.15767. [PubMed 30693946]
*Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 125.
*Baskin SI, and Esdale A, “Is Chlordiazepoxide the Rational Choice Among Benzodiazepines?” Pharmacotherapy, 1982, 2(2):110-19. [PubMed 6152590]
*Bergman U, Rosa FW, Baum C, et al, "Effects of Exposure to Benzodiazepine During Fetal Life," Lancet, 1992, 340(8821):694-6. [PubMed 1355799]
*Chlordiazepoxide [prescribing information]. Cranbury, NJ: Solco Healthcare; December 2017.
*Dolder CR, Nelson MH. Hypnosedative-induced complex behaviours: incidence, mechanisms and management. CNS Drugs. 2008;22(12):1021-1036. doi:10.2165/0023210-200822120-00005. [PubMed 18998740]
*Iqbal MM, Sobhan T, Ryals T, et al, "Effects of Commonly Used Benzodiazepines on the Fetus, the Neonate, and the Nursing Infant," Psychiatr Serv, 2002, 53(1):39-49. [PubMed 11773648]
*Jennum P, Baandrup L, Ibsen R, et al. Increased all-cause mortality with use of psychotropic medication in dementia patients and controls: A population-based register study. Eur Neuropsychopharmacol. 2015;25(11):1906-1913. doi: 10.1016/j.euroneuro.2015.08.014. [PubMed 26342397]
*Librium (chlordiazepoxide) [prescribing information]. Costa Mesa, CA: ICN Pharmaceuticals Inc; July 2005.
*Mancuso CE, Tanzi MG, Gabay M. Paradoxical reactions to benzodiazepines: literature review and treatment options. Pharmacotherapy. 2004;24(9):1177-1185. [PubMed 15460178]

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[[Category:Pharmacology]]