Chlordiazepoxide

Class
Anxiolytics
Subclass
Benzodiazepines
Substance name
chlordiazePOXIDE hydrochloride
Brand names
Librax®, Librium®
Common formulations
Capsule
Dosage and administration
Adults patients
Symptomatic relief
Alcohol withdrawal syndrome
•
Maintenance: 50-100 mg PO PRN until agitation is controlled
•
Maximum: 300 mg per day
Alternative
•
Start at: 50-100 mg PO QID on day 1
•
Maintenance: 25-50 mg PO QID on days 2 and 3
•
Maximum: 300 mg per day
Anxiety • Mild-to-moderate
•
5-10 mg PO q6-8h
Use 5 mg q6-12h in elderly patients or in the presence of debilitating disease.
Anxiety • Severe
•
20-25 mg PO q6-8h
Use 5 mg q6-12h in elderly patients or in the presence of debilitating disease.
Treatment
Anxiety disorders • Mild-to-moderate
•
5-10 mg PO q6-8h
Use 5 mg q6-12h in elderly patients or in the presence of debilitating disease.
Anxiety disorders • Severe
•
20-25 mg PO q6-8h
Use 5 mg q6-12h in elderly patients or in the presence of debilitating disease.
Other off-label uses
•
Treatment of panic disorder
Indications for use
Labeled indications
Adults
•
Symptomatic relief of alcohol withdrawal syndrome
•
Symptomatic relief of anxiety (mild-to-moderate)
•
Symptomatic relief of anxiety (severe)
•
Treatment of anxiety disorders (mild-to-moderate)
•
Treatment of anxiety disorders (severe)
•
Treatment of preoperative anxiety
Off-label indications
Adults
•
Treatment of panic disorder
Safety risks
Contraindications
Acute angle-closure glaucoma
A known or suspected hypersensitivity to chlordiazepoxide
Pre-existing respiratory insufficiency
Prostatic hypertrophy or benign bladder neck obstruction (bladder obstruction)
Warnings and precautions
Angioedema
•
Use caution with benzodiazepine hypersensitivity.
Depression
•
Use caution with a history of depression.
Drug abuse
•
Use caution with a history of alcoholism or substance abuse.
Exacerbation of porphyria
•
Use caution with pre-existing porphyria.
Myasthenia gravis
•
Use caution with a neuromuscular disease.
Respiratory depression
•
Use caution coadministration with other CNS depressants.
Seizures
•
Use caution with a history of a seizure disorder.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for excessive sedation.
eGFR 10-20 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for excessive sedation.
eGFR < 10 mL/min/1.73 m²
•
Reduce dose by 50%. Monitor for excessive sedation.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required. Monitor for excessive sedation.
Intermittent hemodialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Reduce dose by 50%. Monitor for excessive sedation.
Peritoneal dialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Reduce dose by 50%. Monitor for excessive sedation.
Hepatic impairment
Any severity
•
Reduce dose. Monitor for toxicity.
Substantial chronic alcohol consumption
•
Use with caution. Monitor for toxicity.
Pregnancy and breastfeeding
Pregnancy
First trimester • Australia Category: C
•
Use only if benefits outweigh potential risks.
Second trimester • Australia Category: C
•
Use only if benefits outweigh potential risks.
Third trimester • Australia Category: C
•
Use only if benefits outweigh potential risks.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Sedation
Common 1-10%
•
Ataxia, confusion, constipation, dry mouth, fatigue, nausea, skin rash, somnolence, vomiting
Uncommon < 1%
•
Agitation, ↓ blood lymphocyte count, jaundice, epigastric pain, headache, restlessness, urinary retention, vertigo
Unknown frequency
•
AKI, drug-induced liver injury, hypotension, jaundice, blurred vision, ↓ libido, depression, hypersalivation, ↑ libido, mania, menstrual irregularity, nervousness, skin rash, weight gain, respiratory depression, tremor, urticaria
Interactions
Drug(s)
Check Interactions
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