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Chlordiazepoxide information from DrugsUpdate  

See Available Brands of Chlordiazepoxide in India

P - Category D
L - Excreted in breast milk
FI - Food *
LI - None well documented

Chlordiazepoxide, is a sedative/hypnotic drug and benzodiazepine derivative. It is marketed under the trade names Klopoxid, Librax (also contains clidinium bromide), Libritabs, Librium, Mesural, Multum, Novapam, Risolid, Silibrin, Sonimen, Tropium, and Zetran. Chlordiazepoxide has a medium to long half life but its active metabolite has a very long half life. The drug has amnestic, anxiolytic, hypnotic and skeletal muscle relaxant properties.

Pharmacodynamics

Pharmacokinetics

Chlordiazepoxide is a long acting benzodiazepine drug. The half life of Chlordiazepoxide is 5 – 30 hours but has an active benzodiazepine metabolite (desmethyldiazepam) which has a half life of 36 – 200 hours. The half life of chlordiazepoxide increases significantly in the elderly which may result in prolonged action as well as accumulation of the drug during repeated administration. Delayed body clearance of the long half life active metabolite also occurs in those over 60 years of age which further prolongs the effects of the drugs with additional accumulation after repeated dosing.

Chlordiazepoxide Indications / Chlordiazepoxide Uses

Information Not Available

Chlordiazepoxide Adverse Reactions / Chlordiazepoxide Side Effects

Cardiovascular
CV collapse; hypotension; hypertension; tachycardia; bradycardia; edema; phlebitis or thrombosis at IV sites.

CNS
Drowsiness; confusion; ataxia; dizziness; fatigue; apathy; memory impairment; disorientation; anterograde amnesia; restlessness; headache; slurred speech; loss of voice; stupor; coma; euphoria; irritability; vivid dreams; psychomotor retardation; paradoxical reactions (eg, anger, hostility, mania, insomnia, muscle spasms); syncope; extrapyramidal symptoms.

Dermatologic
Rash.

EENT
Visual or auditory disturbances; depressed hearing; blurred vision.

GI
Constipation; diarrhea; dry mouth; coated tongue; nausea; anorexia; vomiting.

Genitourinary
Menstrual irregularities; increase or decrease in libido.

Hematologic
Blood dyscrasias including agranulocytosis; anemia; thrombocytopenia; leukopenia; neutropenia.

Hepatic
Abnormal LFTs; hepatic function impairment including hepatitis and jaundice.

Miscellaneous
Dependency/withdrawal syndrome.

Precautions

Monitor.

CBC
Ensure that CBC with differential and liver enzymes are evaluated periodically in patient on prolonged therapy.

Periodic therapy review
Ensure that therapy is periodically reviewed to determine if therapy needs to be continued without change or if a dose change (eg, increase, decrease, discontinuation) is indicated.


Response to treatment
Frequently assess patient for response to treatment. Notify health care provider if condition does not appear to improve or worsens.

Withdrawal
If treatment is to be discontinued, or the dose reduced, gradually taper the dose and monitor patient for withdrawal symptoms. If significant withdrawal symptoms develop (eg, increased anxiety, tremor, muscle or abdominal cramps, sweating) reinstitute previous dosing schedule and attempt a less rapid tapering regimen after patient has stabilized.

Special Precautions

Information Not Available

Other Drug Interactions

Alcohol and CNS depressants
Additive CNS depressant effects are possible.

Azole antifungal agents (eg, itraconazole, ketoconazole), fluvoxamine, isoniazid, nefazodone, protease inhibitors (eg, indinavir)
May increase chlordiazepoxide plasma concentrations.

Cigarette smoking, theophyllines
May antagonize sedative effects.

Cimetidine, oral contraceptives, disulfiram, omeprazole
May increase effects of chlordiazepoxide with excessive sedation and impaired psychomotor function.

Digoxin
May increase serum digoxin concentrations.

Rifamycins
May decrease chlordiazepoxide plasma concentrations.

Other Interactions

Librium is a central nervous system depressant and may intensify the effects of alcohol or have an additive effect. Do not drink alcohol while taking Librium.

Dosage

Individualize dosage. Acute symptoms may be rapidly controlled IM or IV, with subsequent oral treatment (max, 300 mg/day).


Children older than 6 years of age.
PO 5 mg 2 to 4 times daily; may be increased to 10 mg 2 to 3 times daily.

Mild to Moderate Anxiety Adults
PO 5 to 10 mg 3 or 4 times daily.

Severe Anxiety Adults
PO 20 to 25 mg 3 or 4 times daily.

Elderly or Debilitated Patients
PO 5mg 2 to 3 times daily.

Preoperative Apprehension/Anxiety Adults
PO 5 to 10 mg 3 or 4 times daily on days preceding surgery.

Acute Alcohol Withdrawal Adults
PO 50 to 100 mg, repeat as needed (max oral or parenteral dose is 300 mg/day).

General Advice
Administer prescribed dose without regard to meals but administer with food if GI upset occurs.

Food(before/after)

Information Not Available

List of Contraindications

Chlordiazepoxide and Pregnancy

Category D


Avoid especially in first trimester because of possible increased risk of congenital malformations.


Chlordiazepoxide and Lactation

Excreted in breast milk

Chlordiazepoxide and Children

Initial dose should be small and gradually increased. Oral form not recommended in children younger than 6 years of age.

Chlordiazepoxide and Geriatic

Initial dose should be small and gradually increased. Use with caution in patients with limited pulmonary reserve.

Chlordiazepoxide and Other Contraindications

Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma.

Storage

Store capsules at controlled room temperature (59° to 86°F).

Lab interference

Store capsules at controlled room temperature (59° to 86°F).

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