chlordiazepoxide LIBRIUM

Class: Benzodiazepine
FDA Indications: Anxiety Disorders, Acute Alcohol Withdrawal, Preoperative Apprehension And Anxiety
Off-Label Use: IBS
Prescribing
FDA Schedule IV
Forms: 5, 10, 25mg capsule
Dose Range: 10-300 mg/day
Starting: Acute alcohol withdrawal: 50-100 mg; dose may be repeated as necessary to a maximum of 300 mg/day
Anxiety: 5-25 mg tid-qid

NAMI drug fact sheet

Precautions
Serious Side Effects: Overdose can result in hypotension, respiratory depression, and coma
Side Effects: sedation/somnolence, confusion, ataxia, visual changes, decreased libido
Pharmacodynamics
1° MOA: GABAAR PAM
Target: GABAA: α3 (moderate), α1 (low-moderate), γ2 (low-moderate), α2 (weak)
Pharmacokinetics
t½: 10 (24-48)° TMAX: 0.5-2°
Absorption Rate: Medium
Lipid Solubility: High
Substrate of: 3A4
Inhibits: ∅ ; Induces:
Active Metabolites: Desmethylchlordiazepoxide, demoxepam (t½ 28-63°), desmethyldiazepam (nordiazepam) (t½ 30-200°), and oxazepam (t½ 5-15°).
DDIs
Misc
  • - the first compound synthesized in the benzodiazepine class and the first marketed in 1960, initially with a primary indication for use in alcohol withdrawal
  • - its relatively long t½ is an advantage as it contributes to a smooth course of alcohol withdrawal
  • - since chlordiazepoxide has 4 active metabolites, accumulation of the metabolites occurs, and it can take 2-3 weeks to reach steady state
Special Populations

Category D—↑ risk of oral cleft by 0.01%, use just before delivery associated with floppy infant syndrome, 3rd trimester use can cause withdrawal in newborns

Excreted in breast milk. Drowsiness, lethargy, or weight loss in nursing infants have been observed in case reports following maternal use of some benzodiazepines

Avoid use; however, use may be appropriate in older adults when used for seizure disorders, rapid eye movement disorders, benzodiazepine or ethanol withdrawal, severe generalized anxiety disorder, or periprocedural anesthesia (Beers Criteria [AGS 2015])

CrCl ≤10 mL/min: No dosage adjustment necessary; CrCl <10 mL/minute: Administer 50% of dose;

There are no dosage adjustments provided in the manufacturer's labeling; however, chlordiazepoxide undergoes hepatic metabolism and should be used with caution.

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Last updated December 05 2018 19:19:12. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.