Dosing and uses of Librium (chlordiazepoxide)
Adult dosage forms and strengths
capsule: Schedule IV
- 5mg
- 10mg
- 25mg
Anxiety
Mild/moderate: 5-10 mg PO q6-8hr
Severe: 20-25 mg PO q6-8hr
Preoperative Apprehension & Anxiety
5-10 mg PO q6-8hr
Acute Alcohol Withdrawal
50-100 mg IV/IM/PO; may repeat PRN after 2-4 hr
Not to exceed 300 mg/day (some clinicians have used doses of 600-800 mg/day)
Geriatric Dosing
Not drug of choice in elderly because of prolonged sedation and increased risk of falls/fractures
Anxiety
- Lower initial dose: 5 mg PO q6-12hr; adjust gradually based on response and incidence of adverse effects
Dosing considerations
- Adjust for renal impairment; administer 50% of recommended dose if CrCl <10 mL/min
Dosing Modifications
Renal impairment
- CrCl <10 mL/min: 50% of recommended dose
- CrCl >10 mL/min: Dose adjustment not necessary (monitor)
Hepatic impairment
- Not studied
Pediatric dosage forms and strengths
capsule: Schedule IV
- 5mg
- 10mg
- 25mg
Anxiety
<6 years: Safety and efficacy not established
>6 years: 0.5 mg/kg/day divided PO q6-8hr, OR 5 mg PO q6-12hr; may increase dose to 10 mg PO q8-12hr
>12 years: 25-50 mg IV/IM q6-8hr
Librium (chlordiazepoxide) adverse (side) effects
>10%
Ataxia
Drowsiness
Memory impairment
Sedation
Muscle weakness
Rash
Decreased libido
Menstrual disorders
Xerostomia
Salivation decreased
Increased/decreased appetite
Weight gain/loss
Micturition difficulties
1-10%
Confusion
Dizziness
Disinhibition
Akathisia
Dermatitis
Hypotension
Salivation increased
Sexual dysfunction
Incontinence
Rigidity
Tremor
Muscle cramps
Tinnitus
Nasal congestion
Warnings
Contraindications
Documented hypersensitivity
Acute alcohol intoxication
Myasthenia gravis (allowable in limited circumstances)
Narrow angle glaucoma (questionable)
Severe respiratory depression
Depressed neuroses, psychotic reactions
IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants
Cautions
Patient should be observed for up to 3 hours following administration
Anterograde amnesia associated with treatment
Use caution in renal and hepatic impairment
Use caution in respiratory disease (COPD), sleep apnea, porphyria, open-angle glaucoma (questionable), depression, suicidal ideation, impaired gag reflex
May impair ability to perform hazardous tasks
Paradoxical reactions, including hyperactive or aggressive behavior, reported
Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use
Pregnancy and lactation
Pregnancy category: d
Lactation: Enters breast milk/not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Librium (chlordiazepoxide)
Mechanism of action
Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through the GABA receptor system. Increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane
Absorption
Bioavailability: Slow and erratic following IM admin
Onset: 1-5 min (IV)
Duration: 15-60 min (IV)
Plasma peak time: Within 2 hr
Distribution
Protein bound: 90-98%
Vd: 3.3 L/kg
Metabolism
Metabolites: Demoxepam, desmethylchlordiazepoxide, desmethyldiazepam, oxazepam
Elimination
Half-life: 6-25 hr (normal liver and renal function); 5-30 hr (end-stage renal disease); 30-63 hr (liver cirrhosis)
Excretion: Urine
Administration
IV Incompatibilities
Solution: NS(?)
Y-site: Cefepime
IV Compatibilities
Solution: D5W, Lr
Y-site: Heparin, hydrocortisone Na-succinate, KCl, vitamin B/C
IV Administration
Preferred over IM due to erratic IM absorption
Slow IVP over >1 min: Rapid administration can cause hypotension, slow respiration, bradycardia
Have airway support available until effects of IV administration known
Patient should be observed for up to 3 hr following administration
Monitor respiration q5-15min after use and before each repeated dose
