Chlordiazepoxide

Chlordiazepoxide

Chlordiazepoxide is a long-acting benzodiazepine that is FDA-approved for the management of anxiety disorder and preoperative apprehension and anxiety among adults.1

Common Brand Names: Librium, Mitran, Poxi, Libritabs

Similar to other benzodiazepines, chlordiazepoxide is a drug with anxiolytic, sedative, and weak analgesic properties. It has been shown to inhibit the neuronal activity in the fear circuits located in the amygdala. This spectrum of actions is responsible for chlordiazepoxide’s anxiolytic, hypnotic, and sedative effects.1

It has a low risk of dependence and a low potential for abuse, which is why the drug is classified as a Schedule IV medication.1 Due to its sedative and relaxing effects, however, some people misuse chlordiazepoxide for long periods. If left unaddressed, chronic misuse of the substance may result in chlordiazepoxide dependence and addiction.

Clinical Uses of Chlordiazepoxide

Chlordiazepoxide is approved by the US FDA in the management of the following conditions:1

  • Moderate to severe anxiety disorder
  • Withdrawal symptoms of alcohol use disorder
  • Anxiety among patients older than six years old

Off-label uses of chlordiazepoxide include treatment for:1

  • Catatonia
  • Bipolar disorder
  • Psychotic disorder

Chlordiazepoxide use is contraindicated in the following cases:1

  • Patients with known allergy or hypersensitivity to chlordiazepoxide or any of its components
  • Patients with angle-closure glaucoma
  • pregnant patients, especially during the first trimester

Physicians must prescribe chlordiazepoxide judiciously to patients suffering from any respiratory disease. Moreover, great care must be taken when prescribing chlordiazepoxide to patients with major depressive disorder, as the substance is known to potentially increase suicidal ideation.1

How Chlordiazepoxide Is Misused or Abused

Because the substance is effective at producing sedative, calming, and even euphoric effects, people may misuse chlordiazepoxide in the following ways:2

  • Taking larger or more frequent doses of chlordiazepoxide than prescribed by their doctor
  • Using chlordiazepoxide to self-medicate (also known as chemical coping)
  • Obtaining chlordiazepoxide from other individuals rather than from their primary prescriber
  • Using chlordiazepoxide along with other substances, such as alcohol or opioid medications
  • Crushing tablets or opening capsules of chlordiazepoxide and inhaling it

Chlordiazepoxide Drug Interactions

It is possible for individuals to experience undesirable side effects when taking chlordiazepoxide with the following substances:

  • Central nervous system (CNS) depressants or opioids: Taking chlordiazepoxide with these can lead to profound respiratory depression and sedation. In severe cases, it can progress to coma and even death.3
  • Alcohol: Both chlordiazepoxide and alcohol depress the central nervous system. Taking them together can increase the side effects of chlordiazepoxide, which include extreme drowsiness, confusion, and impaired muscle control.3

Expected Adverse Outcomes of Chlordiazepoxide

Chlordiazepoxide is considered one of the least harmful benzodiazepine derivatives. However, like all other medications, chlordiazepoxide may be associated with several adverse effects, including:1

  • Dizziness
  • Weakness
  • Confusion
  • Fatigue
  • Forgetfulness
  • Sedation
  • Depression
  • Body incoordination
  • Slurred speech

Some rare side effects of chlordiazepoxide use include:1

  • Weight gain
  • Mania
  • Hallucination
  • Dry mouth
  • Increased salivation
  • Skin eruptions
  • Menstrual irregularities
  • Hypotension

Although instances of these are rare, chlordiazepoxide may also cause severe, life-threatening adverse effects, especially when taken in excessive amounts. These include:1

  • Kidney or liver diseases (also known as renal and hepatic dysfunction)
  • Abnormal blood conditions, or blood diseases (also known as blood dyscrasias)
  • Respiratory depression

Long-Term Effects of Chlordiazepoxide

Chlordiazepoxide is generally only prescribed for short-term use. Long-term use of the substance is not recommended, as there are currently no clinical studies of the drug’s effectiveness when it is used for longer than four months.3

At least one study involving mice, however, has shown that chlordiazepoxide can induce sperm head abnormalities beginning at three weeks of use.4

Signs of Chlordiazepoxide Overdose

When a person has developed either a tolerance or an addiction to chlordiazepoxide, they may continually increase the doses they consume, or take the drug more frequently as a result. This, in turn, can cause an individual to overdose on chlordiazepoxide and experience the following symptoms:3

  • Confusion
  • Diminished reflexes or muscle weakness
  • Drowsiness
  • Respiratory depression
  • Somnolence, or general depressed activity
  • Excitation
  • Coma

Should you notice any of these signs in yourself or another individual, immediately call 911 or your local emergency services.

Chlordiazepoxide Addiction: Signs to Look Out For

Chlordiazepoxide has a significant potential for causing physical and psychological dependence.3 As such, chronic misuse of the drug can lead to chlordiazepoxide addiction, particularly in patients with a history of substance use disorder or those who are on chronic chlordiazepoxide therapy.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists 11 pathological behavioral patterns that are typically indicative of substance use disorders (SUD). These patterns can also be seen in individuals who are suffering from chlordiazepoxide use disorder. The criteria for the clinical diagnosis of chlordiazepoxide use disorder are listed below:5

  • Taking chlordiazepoxide in excessively large amounts or for a longer time than prescribed
  • Not being able to reduce or stop chlordiazepoxide use despite many attempts to do so
  • Spending a lot of time trying to get or use chlordiazepoxide, or taking a long time recovering from using chlordiazepoxide
  • Feeling strong cravings for chlordiazepoxide
  • Becoming unable to fulfill one’s personal, social, and family obligations due to chlordiazepoxide use
  • Continuing to take chlordiazepoxide, even if it results in interpersonal problems
  • Letting go of or missing out on important social and recreational activities due to using chlordiazepoxide
  • Continuing chlordiazepoxide use, even if it may cause you to get into high-risk or dangerous situations
  • Continuing to take chlordiazepoxide despite it worsening or exacerbating existing medical conditions or causing new ones
  • Requiring higher doses of chlordiazepoxide in order to achieve or maintain its desired effects in the body (tolerance)
  • Developing withdrawal symptoms after abrupt termination of chlordiazepoxide use (withdrawal)

Chlordiazepoxide Withdrawal Symptoms

Abrupt cessation of chlordiazepoxide use can lead to withdrawal symptoms, such as:3

  • Vomiting
  • Increased sweating
  • Muscle cramps
  • Tremors
  • Convulsions

Should you notice any of these signs upon discontinuing the use of chlordiazepoxide, this could mean that you have developed a dependence on the substance. Because the body has gotten used to the presence of the drug in the body, abruptly stopping chlordiazepoxide intake can be uncomfortable or dangerous.

It is important to note, however, that a dependence on chlordiazepoxide is not the same as an addiction to it. The former condition can occur even in patients who take the drug as prescribed for therapeutic reasons. By contrast, addiction is a disorder that is characterized by the continued use of a substance despite the negative consequences of doing so.

Should you suspect that you or another individual have developed a dependence or addiction to chlordiazepoxide, seeking the help of a medical professional is key to recovery. They can help you develop an effective treatment strategy so that you can slowly and safely remove the drug from your body.

Chlordiazepoxide Detox

Detoxification, or detox, refers to the elimination of any drug or substance (in this case, chlordiazepoxide) that has accumulated in the body over time because of chronic misuse. The goal of detoxification is to reverse the patient’s dependence and tolerance to the drug and let the body recover from the damage caused by the chronic misuse of the substance.

The patient must be gradually tapered off the medication to give the brain enough time to correct the disrupted neural pathways. Otherwise, the patient may exhibit severe and potentially dangerous withdrawal symptoms. It is best to bring the patient to a qualified treatment center so that professionals can properly supervise detoxification from the drug.

A chlordiazepoxide detox program typically involves the following processes:

  • Slow discontinuation of the drug over a certain period of time, in a process called tapering.
  • Drug replacement therapy, a process in which chlordiazepoxide is replaced with an alternative drug that has the same anxiolytic effects but with a much lower potential for misuse.
  • Round-the-clock medical supervision to ensure the patient’s safety and comfort throughout the detoxification process.

Treatment of Chlordiazepoxide Addiction: What to Expect

Individuals who are struggling with chlordiazepoxide use disorder may benefit from seeking professional treatment in the form of drug rehabilitation programs. Such programs are typically carried out in either inpatient or outpatient facilities, depending on several factors such as the severity of drug dependence, the patient’s financial status, and the level of their commitment to treatment.

  • Outpatient chlordiazepoxide addiction treatment: Generally, outpatient therapy may be more suitable for patients with mild drug dependence and whose adherence to therapy can be guaranteed. In this kind of setup, patients are allowed to live at home and go about their usual activities. They will only be required to attend regular counseling and therapy sessions at a treatment center.
  • Inpatient chlordiazepoxide addiction treatment: Inpatient rehab programs may be recommended for people experiencing severe withdrawal symptoms or those with a history of non-compliance to therapy. Unlike outpatient rehab programs, this requires the patient to stay at an inpatient or residential facility so that their treatment can be supervised 24/7 by a team of medical professionals.

Because no single treatment is right for everyone, a comprehensive evaluation of the patient is necessary before beginning any drug rehab program to ensure that the strategies to be employed are tailor-fit to their needs and capacities. This includes complete history taking, physical examination, and laboratory workups.

Psychotherapy can also be utilized to reduce relapse episodes and promote abstinence. These psychological approaches help patients identify their relapse triggers and teach them ways to overcome them successfully.

Get in Touch with a Recovery Support Specialist

If you or any of your loved ones are struggling to recover from chlordiazepoxide use disorder, a benzodiazepine addiction treatment program may be able to help. That being said, many people hesitate to seek professional assistance because of how costly it can be.

Fortunately, most insurance plans can provide patients with coverage for substance use disorder treatment services. In the event that you don’t have an insurance plan or if your plan doesn’t cover these types of programs, you can still obtain financial assistance in many other ways.

To get more information about how to go about this, just dial 1-800-429-7690 and you’ll be connected to a recovery support advisor. They can help you determine what treatment program will be best for you or your loved one. Additionally, they can check your insurance coverage and help you find financial assistance to pay for your treatment program. We can also help you find a suitable drug rehab facility for your needs.

Development and History of Chlordiazepoxide

Chlordiazepoxide was first synthesized in 1955 by Dr. Leo Sternbach,6 a chemist who was then working at Hoffman-La Roche.7 He had accidentally discovered the compound while attempting to create something else. Pharmacological testing showed that chlordiazepoxide was a more effective tranquilizer than meprobamate. It was also considered quite safe thanks to promising toxicological test results.8

The US Food and Drug Administration approved the marketing of chlordiazepoxide under the brand name Librium in February 1960.6

Resources

  1. Ahwazi, H. H. & Abdijadid, S. (2020). Chlordiazepoxide: StatPearls.
  2. Weaver, Michael F. (2015). Prescription Sedative Misuse and Abuse. Yale Journal of Biology and Medicine, 88(3): 247-256.
  3. U.S. Food and Drug Administration. (2016). Librium C-IV (chlordiazepoxide HCI) Capsules.
  4. Kar, R.N. & Das, R.K. (1983). Induction of Sperm Head Abnormalities in Mice by Three Tranquilizers. Cytobios.
  5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  6. Malamed, Stanley F. (2017). Sedation (6th ed.).
  7. Wick, J. Y. (2013). The History of Benzodiazepines. The Consultant Pharmacist, 28(9): 538-548.
  8. Baenninger, Alex. (2004). Good Chemistry: The Life and Legacy of Valium Inventor Leo Sternbach.

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