From the FDA Drug Label
DOSAGE AND ADMINISTRATION: ... For the relief of withdrawal symptoms of acute alcoholism, the parenteral form* is usually used initially. If the drug is administered orally, the suggested initial dose is 50 to 100 mg, to be followed by repeated doses as needed until agitation is controlled — up to 300 mg per day
Since the question is about mild alcohol withdrawal with a CIWA score of < 8, the dose is not explicitly stated for this specific scenario.
The dose of Librium (chlordiazepoxide) for mild alcohol withdrawal with a CIWA score of < 8 is not directly stated in the FDA drug label. However, for the relief of withdrawal symptoms of acute alcoholism, the suggested initial dose is 50 to 100 mg, to be followed by repeated doses as needed until agitation is controlled — up to 300 mg per day 1.
- Key points:
- Initial dose: 50 to 100 mg
- Maximum daily dose: up to 300 mg
- Dosing should be individualized and titrated to effect. It is essential to note that the FDA label does not provide a specific dose for mild alcohol withdrawal with a CIWA score of < 8, and clinical judgment should be used to determine the appropriate dose.
From the Research
For mild alcohol withdrawal with a CIWA score less than 8, Librium (chlordiazepoxide) is typically given at a dose of 25-50 mg orally every 6 hours as needed, as supported by the most recent study 2. This symptom-triggered approach allows for medication administration only when the patient is experiencing withdrawal symptoms, which helps prevent over-sedation. The medication can be continued for 1-3 days, with close monitoring of the CIWA score to adjust dosing as needed. Some key points to consider when managing alcohol withdrawal include:
- Regular reassessment of the patient, as withdrawal symptoms can escalate quickly
- Adjustment of the dosing regimen if the CIWA score increases above 8, indicating moderate withdrawal
- Preference for Librium due to its long half-life, which provides a smoother tapering effect and helps prevent breakthrough symptoms or seizures
- Monitoring of vital signs and assessment for signs of sedation or respiratory depression
- Provision of adequate hydration, electrolyte replacement, and thiamine supplementation (typically 100 mg daily) as part of comprehensive withdrawal management, as noted in various studies 3, 4, 5, 6. It's also important to note that non-benzodiazepine therapy may have similar effectiveness compared to benzodiazepine treatment based on CIWA-Ar total scores, as found in a recent systematic review-based meta-analysis 2.