Chlordiazepoxide

Definition

Chlordiazepoxide is used for the treatment of anxiety. It is a member of the benzodiazepine family of compounds, which slow the central nervous system in order to ease tension or nervousness. In the United States, it is sold under the trade name of Librium.

Purpose

Chlordiazepoxide is used for the short-term relief of symptoms of anxiety and management of anxiety disorders. It is also used for treating symptoms of withdrawal from acute alcoholism and alcoholic intoxication.

Description

Chlordiazepoxide is useful when treating anxiety for short periods of time. It has sedative properties that are useful for brief periods of use. It is occasionally used to stimulate appetites and is a weak analgesic. The precise mechanism of action is not known. Several hours are needed for peak levels of the drug to be achieved. Chlordiazepoxide is available in 5-, 10-, and 25-mg capsules.

Recommended dosage

Recommended dosage varies with diagnosis . The lowest possible dosage that provides relief from symptoms should be used as the drug has a high potential to cause physiological and psychological dependence. When used in adults for the treatment of moderate anxiety, the usual oral dosage is 5–10 mg three or four times per day. When used for the treatment of more severe anxiety and anxiety disorders , the usual oral dosage is 20–25 mg three or four times per day. When used by older persons, or to relieve symptoms of preoperative apprehension or anxiety, the usual oral dosage is 5 mg two to four times per day. If used as a preoperative medication, the usual dosage is 50–100 mg via intramuscular (IM) injection. When used to treat symptoms of acute alcoholism, the usual initial oral dosage is 50–100 mg, repeated as needed until agitation is adequately controlled. The recommended maximum dosage is 300 mg per day. The usual dosage for children is 5 mg two to four times per day.

Precautions

Persons with suicidal tendencies should be closely monitored, as chlordiazepoxide may lower the threshold for action and attempting suicide . The drug has a high potential to cause physiological or psychological dependence.

Side effects

Other than physiological and psychological dependence, few adverse effects have been reported. The most commonly reported include drowsiness, confusion, and difficulty in moving. These are most common among older persons. Occasionally, transient loss of consciousness has been reported.

Other adverse effects include edema (abnormal accumulation of fluid in bodily tissues), minor menstrual irregularities, nausea, constipation and, infrequently, changes in libido (sex drive). Also, it may impair mental or physical skills needed to perform complex motor tasks. For this reason, persons using this drug are advised not to drive automobiles or operate machinery.

Interactions

Chlordiazepoxide may increase the effect of alcohol or other substances that depress central nervous system functions. For this reason, they should not be used at the same time. A small number of reports of interaction with oral anticoagulants have been received, and it may exacerbate porphyria—a group of inherited disorders in which there is abnormally increased production of substances called porphyrins.

See also Addiction ; Alcohol and related disorders ;

Resources

BOOKS

Adams, Michael and Norman Holland. Core Concepts in Pharmacology. Philadelphia: Lippincott-Raven, 1998.

Albers, Lawrence J., M.D., Rhoda K. Hahn, M.D., and Christopher Reist, M.D. Handbook of Psychiatric Drugs. 2001–2002. Laguna Hills, CA: Current Clinical Strategies Publishing, 2001.

Foreman, John C. and Torben Johansen. Textbook of Receptor Pharmacology. 2nd ed. Boca Raton, FL: CRC Press, 2002.

Page, Clive P., and Michael Murphy. Integrated Pharmacology. St. Louis: Mosby-Year Book, 2002.

Von Boxtel, Chris J., Budiono Santoso, and I. Ralph Edwards. Drug Benefits and Risks: International Textbook of Clinical Pharmacology. New York: John Wiley & Sons, 2001.

PERIODICALS

Alexopoulou A., A. Michael, and S. P. Dourakis. "Acute thrombocytopenic purpura in a patient treated with chlordiazepoxide and clidinium." Archives of Internal Medicine 161, no. 14 (2001): 1778-1779.

ORGANIZATIONS

American Academy of Clinical Toxicology. 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105-8820. Telephone: (717) 558-7750. FAX: (717) 558-7845. Web site: <http://www.clintox.org/index.html> .

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone: (913) 906-6000. Web site: <http://www.aafp.org/> .

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org/> .

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax: (202) 682-6850. Web site: <http://www.psych.org/> .

American Society for Clinical Pharmacology and Therapeutics. 528 North Washington Street, Alexandria, VA 22314. Telephone: (703) 836-6981. Fax: (703) 836-5223.

American Society for Pharmacology and Experimental Therapeutics. 9650 Rockville Pike, Bethesda, MD 20814-3995. Telephone: (301) 530-7060. Fax: (301) 530-7061. Web site: <http://www.aspet.org/> .

L. Fleming Fallon, Jr., M.D., Dr.P.H.