What is the use of Chlordiazepoxide (Librium)?

From the Guidelines

Chlordiazepoxide (Librium) is primarily used to treat alcohol withdrawal syndrome (AWS).

Key Points

• Chlordiazepoxide is a long-acting benzodiazepine that provides more protection against seizures and delirium in patients with AWS 1.
• The recommended dosage of chlordiazepoxide for AWS is 25-100 mg every 4-6 hours, with a symptom-triggered regimen rather than a fixed dose schedule 1.
• Chlordiazepoxide is considered a 'gold standard' treatment for AWS, given its efficacy in reducing withdrawal symptoms and the risk of seizures and/or delirium tremens 1.
• However, clinicians should avoid using benzodiazepines, including chlordiazepoxide, beyond the initial 10-14 days of treatment due to the potential risk of abuse 1.
• Other medications, such as baclofen and sodium oxybate, are being evaluated for their efficacy in treating AWS and alcohol use disorder (AUD) 1.

Clinical Considerations

• Patients with severe AWS, advanced age, recent head trauma, liver failure, respiratory failure, or other serious medical comorbidities may require alternative treatments, such as lorazepam 1.
• Thiamine should be given to all patients with AWS to prevent Wernicke's encephalopathy, with a recommended dosage of 100-300 mg/day 1.
• Patients at risk of severe withdrawal or with concurrent serious physical or psychiatric disorders should be managed in an inpatient setting 1.

From the FDA Drug Label

INDICATIONS AND USAGE: Chlordiazepoxide HCI Capsules are indicated for the management of anxiety disorders or for the short-term relief of symptoms of anxiety, withdrawal symptoms of acute alcoholism, and preoperative apprehension and anxiety. The use of Chlordiazepoxide (Librium) is for:

• Management of anxiety disorders
• Short-term relief of symptoms of anxiety
• Withdrawal symptoms of acute alcoholism
• Preoperative apprehension and anxiety 2

From the Research

Use of Chlordiazepoxide (Librium)

• Chlordiazepoxide, also known as Librium, is a benzodiazepine that was first introduced in 1960 3, 4, 5.
• It was initially marketed as a tranquilizer without the sedative properties and abuse, addiction, tolerance, and dependence potential of the barbiturates, and other sedative/hypnotic drugs 4.
• Chlordiazepoxide is used to treat anxiety disorders, and it has been shown to be effective in reducing symptoms of alcohol withdrawal 6.
• The drug has been used to treat uncomplicated alcohol withdrawal, and it has been compared to other benzodiazepines such as lorazepam in terms of efficacy and safety 6.
• Chlordiazepoxide has also been studied for its effects on human psychomotor and cognitive functions, and it has been found to have little to no adverse effects on higher mental functions 7.

Therapeutic Uses

• Anxiety disorders: Chlordiazepoxide is used to treat anxiety disorders, including generalized anxiety disorder and panic disorder 3, 5.
• Alcohol withdrawal: Chlordiazepoxide is used to treat uncomplicated alcohol withdrawal, and it has been shown to be effective in reducing symptoms of withdrawal 6.
• Other uses: Chlordiazepoxide may also be used to treat other conditions, such as insomnia and seizures, although its use for these conditions is less common 4, 7.

Mechanism of Action

• Chlordiazepoxide works by interacting with neurotransmitters, especially GABA, and it has specific receptors in the brain and central nervous system 7.
• The drug has a calming effect on the nervous system, which helps to reduce anxiety and other symptoms associated with anxiety disorders 3, 5.