Chlordiazepoxide, also known as Librium, is a long-acting benzodiazepine, primarily used in the treatment of anxiety disorders. This medication should be taken exactly as prescribed and it is advised to consult with your doctor before starting any other medication (prescribed or over the counter) while taking chlordiazepoxide, as adverse effects and dependency can occur.

Chlordiazepoxide brand names

  • Librium
  • Librax

What is chlordiazepoxide prescribed for?

Chlordiazepoxide is prescribed to treat anxiety disorders and withdrawal symptoms of alcohol use disorder (alcoholism) such as delirium tremens and tremors.

Chlordiazepoxide is approved for the treatment of anxiety in children aged six and above, although doses for children are typically much lower than for adults, because of the increased risk of side effects.[1]

Being a benzodiazepine medicine, Chlordiazepoxide is a Schedule IV controlled substance, due to its potential for dependency and misuse. As such, pharmacies will only dispense a certain number of tablets at a time and repeat prescriptions are limited.[2]

How does chlordiazepoxide work?

Chlordiazepoxide works by increasing the effects of a neurotransmitter called Gamma-Aminobutyric acid (GABA), which results in a reduction of activity in certain areas of the brain. This leads to a reduction in fear and anxiety, relaxes the muscles, increases appetite, and provides a sedative effect.[3]

How is chlordiazepoxide usually taken?

Chlordiazepoxide is available in 5mg, 10mg, 25mg, and 100mg capsules, which should be swallowed whole.

Because of the potential for physical and mental dependency to develop with extended use, chlordiazepoxide should not be taken for longer than four months.[1] As such, it is typically used to treat symptoms of acute anxiety, rather than as a long-term treatment.[4]

For adults with mild to moderate anxiety, chlordiazepoxide is prescribed in 5mg or 10mg doses, to be taken 3-4 times per day.

For adults with severe anxiety, chlordiazepoxide is prescribed in 20mg or 25mg doses, to be taken 3-4 times per day.

For children aged 6 and above, or adults over 65 years old, chlordiazepoxide is prescribed as a 5mg dose, to be taken 2-4 times per day.

For withdrawal symptoms of alcohol use disorder, chlordiazepoxide is prescribed in 50-100mg doses, which can be taken every two hours, up to a maximum of 300mg per day.

This medication should be taken as prescribed, without missing a dose. If a dose is missed, take the medication as soon as possible, or if it is close to the next dosage time, skip the missed dose. Never take double your prescribed dose in one go, as this can have adverse effects and may increase the risk of side effects and dependency.

How long does chlordiazepoxide stay in your system?

After your first dose of chlordiazepoxide, you may begin to notice changes in your symptoms within the first few hours, although the full therapeutic effect of the medication may take several weeks.[3] The effects of a single dose can last for up to a day and a half.[1]

Following your final dose of chlordiazepoxide, it may take several days or weeks for the medication to be entirely out of your system, depending on the dosage and length of your treatment.

Do not suddenly stop taking chlordiazepoxide, even if you feel better, as this can have an impact on your physical and mental health and can cause withdrawal symptoms. If your doctor advises that it is safe to come off this medication, they will likely reduce your prescription slowly, to prevent withdrawal symptoms from occurring.

Chlordiazepoxide side effects

When you start taking a new medication, you may experience some common side effects. These will likely reduce within the first few weeks, but if they continue or become problematic, contact your doctor, as you may need a reduced dose or a change of medication.

Common side effects of chlordiazepoxide include:

  • Nausea
  • Constipation
  • Dizziness
  • Diarrhea
  • Severe drowsiness
  • Uncontrollable movements
  • Muscle weakness
  • Confusion
  • Dry mouth
  • Excessive saliva
  • Increase in appetite or weight
  • menstrual irregularities

Serious side effects of chlordiazepoxide are less common but may still occur. If you experience any of the following, contact your doctor immediately:

  • Breathing difficulties
  • Stomach pain
  • Increased blood pressure
  • Rash or blisters
  • Yellowing of the skin or eyes
  • Irregular heartbeat
  • Fever
  • Tremors or shaking
  • Slurred speech
  • Hallucinations or delusions
  • Mania
  • Thoughts of harming yourself or others

Chlordiazepoxide precautions

It is important that your doctor is aware of any past or present mental health conditions you have experienced, to enable safe monitoring of your condition while on this medication, or to decide if it is safe for you.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely. Inform your doctor if you have had heart, kidney, or liver conditions, seizures, glaucoma, or breathing problems, as it may not be safe, or your doctor may wish to closely monitor your physical health during your treatment.[1][5]

Tell your doctor about all medications you are currently taking or plan to take (including vitamins, herbal supplements, and dietary supplements), as they may cause adverse reactions.

Ensure you tell your doctor if you are pregnant or planning to get pregnant, as chlordiazepoxide has been found to cause harm to the fetus, particularly if used in the first trimester.[1][3] As such, it is better to avoid using this medication while pregnant. There are alternative medications that your doctor can advise on.

Tell your doctor if you are breastfeeding, as small amounts of chlordiazepoxide may be passed to your baby through breast milk.[1] It may still be safe to take this medication while breastfeeding, but caution is advised, and you may wish to monitor your baby for any unusual changes to their physical or mental state.

It is possible to develop a physical or mental dependence or addiction to chlordiazepoxide.[1][6] As such, it may not be advisable for you to utilize this medication if you have previously experienced an alcohol or substance dependency.

Depending on your dose and the length of time you have taken chlordiazepoxide, you may experience withdrawal symptoms when stopping the medication. Your doctor will likely reduce your prescription slowly, to help prevent this. It is important to follow their advice and prescription carefully during this process, to prevent withdrawal symptoms or misusing your medication.

Chlordiazepoxide can make you feel drowsy, so it is advised not to drive while on this medication, or until you know how it will affect you and it is safe to do so.

Adults over 65 years old may be at higher risk of experiencing side effects from chlordiazepoxide.[1] There are alternative medications that may be safer for this age group.

Chlordiazepoxide interactions

Opioid medications should not be taken while you are taking chlordiazepoxide, as this can greatly increase the risk of overdose, increased sedation, breathing difficulties, coma, or even death.[5]

Similarly, it is advised not to drink alcohol or take any other substance that may impact the central nervous system while taking chlordiazepoxide, as this can also increase sedation and cause further risks.

Some medications may interact with chlordiazepoxide, increasing the risk of serious side effects. This includes some antihistamines, antidepressants, medications for seizures, heart conditions, and asthma, some oral contraceptives, disulfiram, and tranquilizers or sedatives. Always discuss your medications with your doctor before starting a new treatment.

Chlordiazepoxide storage

Always keep all medications out of reach of children.

Store chlordiazepoxide in its original packaging, in airtight containers, and at room temperature (between 68°F and 77°F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on chlordiazepoxide

If you overdose on chlordiazepoxide, contact a medical professional or Poison Control on 1-800-222-1222, or in case of an emergency, call 911. Symptoms of a chlordiazepoxide overdose include confusion, slowed breathing, feeling weak, and loss of consciousness.

Frequently asked questions about chlordiazepoxide

How long does it take for chlordiazepoxide to work?

Chlordiazepoxide may begin to improve your symptoms within a few hours of your first dose, although the full effects of the medication may take several weeks.[3] As such, it is important to follow the advice and prescription given by your doctor, to gain the full benefit of your medication and prevent adverse effects.

Is chlordiazepoxide addictive?

Yes, chlordiazepoxide is an addictive substance, as physical and mental dependency can occur. This is more likely with higher doses and longer treatment, so it is typically only a short-term treatment and should not be taken for longer than four months.[4][7] It is important to take your medication exactly as prescribed by your doctor.

Never stop taking this medication suddenly, or take more than is prescribed, as this can cause unpleasant physical and mental side effects, known as withdrawal symptoms. When your doctor advises that you come off this medication, they will reduce your prescription slowly, to help prevent withdrawal symptoms from occurring.

Can you drink alcohol with chlordiazepoxide?

It is strongly advised that you avoid drinking alcohol while on chlordiazepoxide, as this can increase the risk of oversedation, breathing problems, and even death.[1][8]

Resources:

  1. ICN Pharmaceuticals, Inc. (Revised 2005). Librium (Chlordiazepoxide Hydrochloride) Medication Guide. Access Data FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/012249s049lbl.pdf
  2. Drug Enforcement Agency (DEA). (2018). Drug Scheduling. DEA. Retrieved from https://www.dea.gov/drug-information/drug-scheduling
  3. Ahwazi, H.H. & Abdijadid, S. (2022). Chlordiazepoxide. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547659/
  4. Lader, M. (1984). Short-Term Versus Long-Term Benzodiazepine Therapy. Current Medical Research and Opinion, 8 Suppl 4, 120–126. Retrieved from https://doi.org/10.1185/03007998409109550
  5. Griffin, C.E., 3rd, Kaye, A.M., Bueno, F.R., & Kaye, A.D. (2013). Benzodiazepine Pharmacology and Central Nervous System-Mediated Effects. The Ochsner Journal, 13(2), 214–223. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/
  6. American Society of Health-System Pharmacists, Inc. (Reviewed 2022). Chlordiazepoxide. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a682078.html
  7. Longo, L. P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. American Family Physician61(7), 2121–2128.https://www.aafp.org/pubs/afp/issues/2000/0401/p2121.html
  8. Guina, J., & Merrill, B. (2018). Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. Journal of Clinical Medicine, 7(2), 17. Retrieved from https://doi.org/10.3390/jcm7020017