Librium (Chlordiazepoxide) Dosing
For anxiety disorders, start with 5-10 mg three to four times daily for mild-to-moderate anxiety, or 20-25 mg three to four times daily for severe anxiety; for acute alcohol withdrawal, initiate with 50-100 mg orally followed by repeated doses as needed to control agitation, up to 300 mg per day, then taper to maintenance levels. 1
Dosing by Clinical Indication
Anxiety Disorders
Mild to Moderate Anxiety:
- 5-10 mg orally, 3-4 times daily is the standard starting dose 1
- This provides 15-40 mg total daily dose depending on symptom severity 1
Severe Anxiety:
- 20-25 mg orally, 3-4 times daily for more severe presentations 1
- This delivers 60-100 mg total daily dose 1
Acute Alcohol Withdrawal
Initial Management:
- Start with 50-100 mg orally as the initial dose 1
- Repeat doses as needed until agitation is controlled, up to a maximum of 300 mg per day 1
- Benzodiazepines including chlordiazepoxide remain the treatment of choice as monotherapy for alcohol withdrawal 2
Maintenance Phase:
- Reduce dosage to maintenance levels once acute symptoms are controlled 1
- The goal is symptom-controlled tapering to prevent rebound withdrawal 1
Special Populations
Geriatric Patients or Debilitating Disease
- 5 mg orally, 2-4 times daily (10-20 mg total daily dose) 1
- Lower doses are essential as chlordiazepoxide increases fall risk, particularly in elderly or frail patients 2
Pediatric Patients (6 years and older)
- 5 mg orally, 2-4 times daily as initial dose 1
- May increase to 10 mg, 2-3 times daily in some children as needed 1
- Use in children under 6 years is not recommended due to limited clinical experience 1
Preoperative Use
- 5-10 mg orally, 3-4 times daily on days preceding surgery 1
Critical Safety Considerations
Contraindications and Cautions:
- Use with caution in severe pulmonary insufficiency 2
- Contraindicated in myasthenia gravis unless the patient is imminently dying 2
- Common adverse effects include delirium, drowsiness, dizziness, and paradoxical agitation 2
Important Caveat: While chlordiazepoxide has been traditionally used for alcohol withdrawal, research suggests it may not be the optimal benzodiazepine choice in all clinical scenarios. Lorazepam demonstrates similar efficacy and may be preferred when liver disease is present or liver function cannot be determined, as chlordiazepoxide's clearance is reduced in hepatic impairment 3, 4. However, the FDA-approved dosing and guideline recommendations support chlordiazepoxide as first-line therapy when no contraindications exist 2, 1.