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Chlordiazepoxide

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Chlordiazepoxide, Librium

  • See Also
  1. Benzodiazepine
  • Class
  1. Long Acting Benzodiazepine
  • Dosing
  1. Anxiety Disorder
    1. Adult: 5 to 10 mg orally 2 to 4 times daily (up to 20 to 25 mg per dose)
    2. Elderly: 5 mg orally 2 to 4 times daily
    3. Child (over age 6 years): 5 mg orally 2 to 4 times daily (up to 10 mg orally 2 to 3 times daily)
  2. Alcohol Withdrawal
    1. See Alcohol Withdrawal
    2. Start 25 to 50 mg orally every 3 to 4 hours as needed
    3. May increase doses to 50-100 mg
    4. Repeat dosing every 3-4 hours up to 300 mg per day
  • Safety
  1. Pregnancy Category X
  2. Avoid in Lactation
  3. Schedule IV Controlled Substance
  • Pharmacokinetics
  1. Onset: 15-30 minutes
  2. Peak Plasma level: 0.5 to 4 hours
  3. Half Life: 7-10 hours (active metabolites 36 to 200 hours)
    1. Chlordiazepoxide has the longest effective half life of any Benzodiazepine
  4. Potency
    1. See Benzodiazepine Equivalents
    2. Chlordiazepoxide 25 mg is equivalent to Diazepam 10 mg
  • Metabolism
  1. Chlordiazepoxide is metabolized first to desmethyldiazepam via CYP1A2
  2. Desmethyldiazepam is then metabolized to Oxazepam via CYP3A4 and CYP2C19
  • Resources
  1. Chlordiazepoxide Capsule (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=e3ff8641-ae8a-4016-acb1-cb1b7890f5ed
  • References
  1. (2019) Med Lett Drugs Ther 61(1578): 121-6
  2. (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia