Home Drug Guide Chlordiazepoxide

Drug Guide

Generic Name

Chlordiazepoxide

Brand Names Librium

Classification

Therapeutic: Anxiolytic, sedative, hypnotic, anti-anxiety agent

Pharmacological: Benzodiazepine

FDA Approved Indications

  • Anxiety disorders
  • Alcohol withdrawal syndrome
  • Preoperative sedation

Mechanism of Action

Enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, leading to sedative, anxiolytic, anticonvulsant, and muscle relaxant properties.

Dosage and Administration

Adult: Initially 5-25 mg 3-4 times daily, dosage adjusted based on response.

Pediatric: Not generally recommended for children due to risk of dependence.

Geriatric: Start at lower doses due to increased sensitivity; usual starting dose 5-10 mg 2-4 times daily.

Renal Impairment: Use with caution; monitor for increased sedation.

Hepatic Impairment: Use with caution; may require dose adjustment.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; 96-98% protein-bound.

Metabolism: Hepatic metabolism to active and inactive metabolites.

Excretion: Renally excreted; metabolites via urine.

Half Life: 5-30 hours (varies with individual factors and metabolites).

Contraindications

  • Hypersensitivity to benzodiazepines
  • Myasthenia gravis
  • Acute narrow-angle glaucoma

Precautions

  • History of substance abuse or dependence
  • Psychosis
  • Depression
  • Pregnancy category D (risk to fetus)
  • Lactation

Adverse Reactions - Common

  • Sedation, drowsiness (Common)
  • Dizziness (Common)
  • Ataxia (Common)

Adverse Reactions - Serious

  • Respiratory depression (Rare)
  • Anterograde amnesia (Rare)
  • Dependence and withdrawal upon discontinuation (Serious, with prolonged use)

Drug-Drug Interactions

  • CNS depressants (e.g., alcohol, opioids) may enhance sedative effects.
  • Other benzodiazepines or sedatives, increase risk of respiratory depression.
  • Theophylline may reduce efficacy.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of sedation, respiratory status, and dependence behaviors.

Diagnoses:

  • Risk for sedation-related accidents
  • Risk for dependence

Implementation: Use lowest effective dose for shortest duration. Monitor mental status and respiratory function.

Evaluation: Assess for relief of anxiety or agitation and monitor for adverse effects.

Patient/Family Teaching

  • Avoid alcohol and other CNS depressants.
  • Do not discontinue abruptly to prevent withdrawal seizures.
  • Report excessive drowsiness, confusion, or difficulty breathing.

Special Considerations

Black Box Warnings:

  • Risks from concomitant use with opioids, including profound sedation, respiratory depression, coma, and death.

Genetic Factors: Metabolism via CYP3A4; genetic variations can affect drug levels.

Lab Test Interference: May interfere with some laboratory tests regarding adrenal or thyroid function.

Overdose Management

Signs/Symptoms: Profound sedation, respiratory depression, coma.

Treatment: Supportive care including airway, breathing, circulation. Flumazenil can be used as an antidote but with caution due to seizure risk.

Storage and Handling

Storage: Store in a tightly closed container at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.