Librium (chlordiazepoxide) is a benzodiazepine anxiolytic (antipanic and antianxiety) medication like prescribed to ease symptoms of anxiety, but only for a short period of time. It works by affecting the way some chemicals in your brain called neurotransmitters pass messages to certain brain cells. It has a calming effect on various functions of your brain and also has some muscle-relaxing effects. In addition to treating anxiety, doctors sometimes prescribe Librium for the uncomfortable and sometimes debilitating symptoms that accompany alcohol withdrawal.

Dosage FAQs

  • In what doses should I take this medication?
    • Anxiety: For healthy adults experiencing mild to moderate anxiety, a dose of 5 mg to 10 mg is given three to four times a day. For severe anxiety, the dose is increased to 20 mg to 25 mg three to four times a day.
    • Acute Alcohol Withdrawal: A dose of 50 mg to 100 mg of is given (intravenous, intramuscular, or orally) and may be repeated after two to four hours, or as required. The daily dose, however, should not exceed 300 mg per day.
       
  • Does dosage change for elderly individuals or children?
    • For elderly individuals experiencing anxiety, a low initial dose of 5 mg two to four times a day may be given orally. The use of Librium in elderly patients is low due to the prolonged sedation the medication causes. This increases the risk of falls and fractures for elderly individuals.
    • For children experiencing anxiety, a dose of 5 mg two to four times a day is prescribed. The dose may be increased until the desired effect is achieved.
       
  • How is this drug processed in my body?
    Librium is well-absorbed in the gastrointestinal tract. After absorption it undergoes metabolism and biotransformation in the liver. After metabolism, it is transformed into its active metabolite desmethyldiazepam. The half-life of Librium is in the range of five to 30 hours. Librium and its metabolites are excreted in the urine.
     

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    Is this drug safe to use if I am pregnant?
    Although the U.S. Food and Drug Administration (FDA) has not assigned this medication to an official pregnancy category, it should be avoided during pregnancy unless there are no alternative treatments and the benefits outweigh any increased risks. Use of this drug after the first trimester has been associated with neonatal withdrawal, depression, hypotonia, and difficulty feeding in newborns.
     
  • How can I get the most out of my treatment with this medication?
    This drug is primarily prescribed by doctors and psychiatrists to treat anxiety-related conditions and alcohol withdrawal. Many anxiety-related conditions are treated with success with different types of psychotherapy. Additionally, while therapy may not always be viable during alcohol withdrawal, it is used in many different capacities to help people remain sober and work on underlying conditions that contribute to the difficulty of addiction. If you are prescribed this drug, consider finding a therapist or counselor with whom you can form a therapeutic relationship. In therapy you may learn positive coping strategies, more about what you are experiencing, and ways to develop a healthy self-care routine to avoid future issues.

Drug Interactions

This drug, in addition to other anxiolytics, has several interactions of which you should be aware. If you are prescribed this drug, ensure your pharmacist and/or doctor highlights the following interactions:

  • Triprolidine: Both Triprolidine and Librium depress the central nervous system and cause excessive sedation. Monitor for increased central nervous system depressant effects during concomitant therapy.
  • Oral contraceptives: Oral contraceptives decrease the metabolism of Librium and causes an increase in adverse and therapeutic effects of the drug.
  • Sedatives or sleeping pills: These medications may cause severe sedation and may be fatal when taken with Librium.
  • Carbamazepine, tricyclic antidepressants, phenytoin and theophylline: These drugs can decrease the effectiveness of Librium.
  • Alcohol and caffeine: Avoid the intake of alcohol and excessive caffeine while taking this medication.

Additionally, the following drugs affect the metabolism of Librium and can cause toxicity if taken with the medication:

  • Cimetidine
  • Clozapine
  • Fluconazole
  • Ketoconazole
  • Indinavir
  • Nelfinavir
  • Itraconazole
  • Omeprazole
  • Ritonavir
  • Saquinavir
  • Voriconazole
  • Telithromycin
  • Ethotoin
  • Mephenytoin
  • Fosphenytoin

Possible Side Effects

The adverse effects of Librium, like all other benzodiazepines, may include:

  • Ataxia (difficulty controlling gait and voluntary muscle movements)
  • Drowsiness and sedation
  • Memory impairment
  • Muscle weakness and fatigue
  • Rash and allergy symptoms
  • Decreased libido
  • Menstrual irregularities
  • Dry mouth
  • Increased/decreased appetite
  • Weight changes
  • Difficulties urinating

Precautions

Use of Librium should be avoided in individuals experiencing following conditions:

  • Myasthenia gravis
  • Acute intoxication with alcohol, narcotics, or other psychoactive substances
  • Severe hypoventilation or decreased respiration
  • Glaucoma
  • Hepatitis and liver cirrhosis
  • Severe sleep apnea
  • Hypersensitivity or allergy to any drug in the benzodiazepine class

In the case of kidney impairment, the dose should be adjusted.

This medication should be used with extreme caution by seniors because of its long half-life.

Chemistry

Librium belongs to a class of drugs called benzodiazepines. These are organic compounds containing a benzene ring combined with isomers of diazepine. It has a molecular mass of 299.755. Librium is odorless and is a white or slightly yellow solid crystal. It is soluble in water, sparingly soluble in alcohol, and insoluble in chloroform, ether, and petroleum spirit.

Withdrawal from Librium

Individuals being treated should not stop taking this medication abruptly. In general, the longer a person has taken this drug, the worse and more common withdrawal symptoms may be. Individual dosage should be tapered down in order to avoid withdrawal symptoms. If you need to stop taking this medication, work out a safe plan with your health care provider.

References:

  1. Assessment of a cholinergic contribution to chlordiazepoxide-induced deficits of place learning in the Morris water maze". Pharmacology Biochemistry and Behavior. 41 (3): 529–38. 2012-10-19. doi:10.1016/0091-3057(92)90368-p. PMID 1316618.
  2. Liljequist R; Palva E; Linnoila M (1979). "Effects on learning and memory of 2-week treatments with chlordiazepoxide lactam, N-desmethyldiazepam, oxazepam and methyloxazepam, alone or in combination with alcohol". International Pharmacopsychiatry. 14 (4): 190–8. PMID 42628.
  3. Sternbach LH (1972). "The discovery of librium". Agents and Actions. 2 (4): 193–6. doi:10.1007/BF01965860. PMID 4557348.

Page content reviewed by James Pendleton, ND.