Home Drug Guide Chlordiazepoxide Hydrochloride

Drug Guide

Generic Name

Chlordiazepoxide Hydrochloride

Brand Names Librium, Chlordiazachel, Lygen, A-poxide

Classification

Therapeutic: Anxiolytic, Sedative, Hypnotic

Pharmacological: Benzodiazepine

FDA Approved Indications

Anxiety disorder
Alcohol withdrawal syndrome
Preoperative sedation

Mechanism of Action

Enhances the effect of gamma-aminobutyric acid (GABA) at GABA-A receptors, resulting in sedative, anxiolytic, anticonvulsant, and muscle relaxant properties.

Dosage and Administration

Adult: Typically 5-25 mg 3-4 times daily, adjusted based on response and tolerability.

Pediatric: Use not generally recommended due to safety concerns.

Geriatric: Start at lower doses (e.g., 5 mg) and titrate carefully.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; metabolic clearance may be reduced.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Primarily metabolized in the liver via hydroxylation and conjugation.

Excretion: Renally excreted as active and inactive metabolites.

Half Life: About 5-30 hours, variable depending on individual factors.

Contraindications

Hypersensitivity to benzodiazepines.
Acute narrow-angle glaucoma.
réputiny Disorder
Pregnancy Category D/S

Precautions

History of substance abuse.
Respiratory insufficiency.
Liver disease.
Use with caution in the elderly; risk of falls and cognitive impairment.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Ataxia (Less common)

Adverse Reactions - Serious

Respiratory depression (Rare)
Paradoxical reactions (e.g., agitation, aggression) (Rare)
Dependence and withdrawal symptoms (Serious with long-term use)

Drug-Drug Interactions

CNS depressants (opioids, alcohol, other sedatives) — increased sedation and respiratory depression.
Antifungals (ketoconazole, itraconazole) — decreased metabolism of chlordiazepoxide.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of excessive sedation, confusion, or respiratory depression.

Diagnoses:

Risk for injury from falls due to sedation.
Impaired cognition or coordination.

Implementation: Administer dose exactly as prescribed. Use caution in activities requiring alertness.

Evaluation: Assess effectiveness in alleviating anxiety or alcohol withdrawal symptoms.

Patient/Family Teaching

Do not drink alcohol while on this medication.
Avoid operating heavy machinery or driving until response is known.
Inform about potential for dependence and withdrawal symptoms.
Take medication exactly as prescribed; do not increase dose without medical advice.

Special Considerations

Black Box Warnings:

Risks of respiratory depression, coma, and death when used with opioids.
Risks of dependence, abuse, and withdrawal reactions.

Genetic Factors: Genetic variation may affect metabolism, especially CYP450 enzymes.

Lab Test Interference: No significant interference noted.

Overdose Management

Signs/Symptoms: Excessive sedation, confusion, hypotension, respiratory depression, coma.

Treatment: Supportive care, airway management, activated charcoal if recent ingestion, flumazenil may be used as antidote in certain cases under supervision.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions for prescribed duration.