What is the dose of Chlordiazepoxide (Librium)?

From the Guidelines

Chlordiazepoxide should be dosed at 25-100 mg orally every 4-6 hours as needed for alcohol withdrawal symptoms. This dosing regimen is based on the most recent and highest quality study available, which provides guidelines for the management of alcoholic liver disease 1. The study recommends a dose range of 25-100 mg every 4-6 hours for chlordiazepoxide, which is consistent with the goal of minimizing morbidity, mortality, and improving quality of life.

Some key points to consider when dosing chlordiazepoxide include:

• The dose should be adjusted based on the severity of symptoms and the patient's response to treatment
• The medication should be used for the shortest duration necessary to minimize the risk of dependence
• Patients should be monitored for side effects, including sedation, dizziness, and confusion, and for respiratory depression, especially when combined with other CNS depressants
• Elderly patients or those with liver impairment may require lower doses, although specific dosing recommendations for these populations are not provided in the study 1

It's worth noting that the study also recommends the use of other medications, such as thiamine, diazepam, and lorazepam, as part of the treatment regimen for alcohol withdrawal syndrome 1. However, the dosing recommendations for chlordiazepoxide are clear and should be followed to minimize morbidity, mortality, and improve quality of life.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: Because of the wide range of clinical indications for chlordiazepoxide, the optimum dosage varies with the diagnosis and response of the individual patient. The dosage, therefore, should be individualized for maximum beneficial effects ADULTSUsual Daily Dose Relief of mild and moderate anxiety disorders and symptoms of anxiety 5 mg or 10 mg, 3 or 4 times daily Relief of severe anxiety disorders and symptoms of anxiety 20 mg or 25 mg, 3 or 4 times daily Geriatric patients, or in the presence of debilitating disease 5 mg, 2 to 4 times daily Preoperative apprehension and anxiety: On days preceding surgery, 5 to 10 mg orally, 3 or 4 times daily. CHILDRENUsual Daily Dose Because of the varied response of children to CNS-acting drugs, therapy should be initiated with the lowest dose and increased as required. Since clinical experience in children under 6 years of age is limited, the use of thedrug in this age group is not recommended 5 mg, 2 to 4 times daily (may be increased in some children to 10 mg, 2 or 3 times daily)

The recommended dose of chlordiazepoxide varies by indication and patient population:

• Mild and moderate anxiety: 5 mg or 10 mg, 3 or 4 times daily 2
• Severe anxiety: 20 mg or 25 mg, 3 or 4 times daily 2
• Geriatric patients: 5 mg, 2 to 4 times daily 2
• Children: 5 mg, 2 to 4 times daily (may be increased to 10 mg, 2 or 3 times daily) 2

From the Research

Chlordiazepoxide Dose

• The dose of chlordiazepoxide is not explicitly stated in the provided studies as a specific recommendation for all patients, but rather as part of comparative studies with other medications like lorazepam and gabapentin 3, 4, 5, 6, 7.
• In the study comparing lorazepam and chlordiazepoxide for alcohol dependence syndrome, chlordiazepoxide was started at a dose of 80 mg/day and tapered down over 8 days 4.
• A similar dosing strategy was used in another study where chlordiazepoxide was given at 80 mg/day, with the dose being down-titrated to zero over 8 treatment days 6.
• In a study comparing gabapentin and chlordiazepoxide for outpatient alcohol detoxification, chlordiazepoxide doses were 100 mg orally for 3 days, followed by 75 mg, 50 mg, and 25 mg for 1 day each 7.
• These studies suggest that the initial dose and tapering schedule of chlordiazepoxide can vary based on the specific patient population and the comparative drug being studied, but a common starting point seems to be around 80 mg/day with gradual tapering 4, 6.

Comparison with Other Medications

• Chlordiazepoxide has been compared with lorazepam in several studies, with findings indicating that lorazepam is noninferior to chlordiazepoxide in reducing alcohol withdrawal symptoms 4, 5, 6.
• One study also compared chlordiazepoxide with gabapentin, suggesting that gabapentin may result in a greater reduction in sedation and alcohol craving by the end of treatment 7.
• The choice between chlordiazepoxide and other medications like lorazepam or gabapentin may depend on factors such as the patient's liver function, the presence of other medical conditions, and the specific symptoms being targeted 3, 7.

Safety and Efficacy

• The safety and efficacy of chlordiazepoxide have been evaluated in various studies, with findings generally supporting its use in the management of alcohol withdrawal symptoms 4, 5, 6.
• However, the potential for adverse effects such as sedation, ataxia, and interactions with other medications should be considered when prescribing chlordiazepoxide 3, 7.
• Monitoring of liver function tests and adjustment of the dose as needed may also be important, especially in patients with pre-existing liver disease 4.