Librium (Chlordiazepoxide) Dosage and Usage
Anxiety Disorders
For mild to moderate anxiety, chlordiazepoxide should be dosed at 5-10 mg orally three to four times daily, while severe anxiety requires 20-25 mg orally three to four times daily. 1
Geriatric or debilitated patients require dose reduction to 5 mg two to four times daily to minimize risks of oversedation and falls. 1
Preoperative anxiety can be managed with 5-10 mg orally three to four times daily on days preceding surgery, or 50-100 mg IM one hour before the procedure if used as preoperative medication. 1
Pediatric dosing (for children over 6 years) starts at 5 mg two to four times daily, which may be increased to 10 mg two to three times daily in some children, though use under age 6 is not recommended due to limited clinical experience. 1
Acute Alcohol Withdrawal
For alcohol withdrawal, the initial oral dose is 50-100 mg, followed by repeated doses as needed until agitation is controlled, up to 300 mg per day, then reduced to maintenance levels. 1
Long-acting benzodiazepines like chlordiazepoxide and diazepam are recommended for alcohol withdrawal syndrome to prevent seizures through GABA activation, providing anxiety relief and sedation. 2
The recommended dosing schedule is chlordiazepoxide 25-100 mg orally every 4-6 hours, with dose tapering as withdrawal symptoms resolve. 2
Symptom-triggered therapy is superior to fixed-schedule dosing, reducing median treatment duration from 68 hours to 9 hours and total chlordiazepoxide dose from 425 mg to 100 mg, without increasing complications. 3
Critical Safety Considerations in Hepatic Insufficiency
Chlordiazepoxide should be avoided in patients with hepatic insufficiency due to the risk of dose-stacking and delayed, profound sedation. 4
Chlordiazepoxide has minimal sedative activity itself—its effect depends primarily on hepatically-metabolized active metabolites, particularly demoxepam (half-life 14-95 hours). 4
In hepatic insufficiency, delayed metabolism leads to accumulation of unmetabolized chlordiazepoxide before therapeutic response occurs, creating a reservoir that slowly converts to long-acting metabolites even after dosing stops. 4
Lorazepam is the preferred benzodiazepine in patients with liver disease, as it undergoes simpler glucuronidation metabolism without active metabolites and shows equivalent efficacy to chlordiazepoxide at doses of 6-8 mg/day. 2, 5, 6
Monitoring and Adjunctive Treatment
All patients with alcohol withdrawal syndrome should receive thiamine 100-300 mg/day to prevent Wernicke encephalopathy, maintained for 2-3 months after symptom resolution. 2
Psychiatric consultation is recommended for evaluation, acute management, and long-term abstinence planning in alcohol withdrawal cases. 2
Inpatient treatment is indicated for serious complications including withdrawal delirium, seizures, or significant medical/psychiatric comorbidities. 2