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.