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

• 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]