Using a benzodiazepine such as chlordiazepoxide, along with an opioid (narcotic) pain medication, may cause profound sedation (a very deep sleep where it is hard to wake up), respiratory depression (breathing may slow or stop), coma, and death. Benzodiazepines and opioids should only be prescribed together when there is no other option available for treatment. When prescribed together, the drugs should be prescribed at the lowest effective dose for the shortest possible period, and the person should be closely monitored.
Chlordiazepoxide is a controlled substance and has the potential for abuse, misuse, and addiction. This can lead to overdose or death. Misusing benzodiazepines such as chlordiazepoxide often involves other medications, alcohol, and/or illegal drugs. Therefore, before prescribing chlordiazepoxide, the healthcare provider will assess the person’s risk for abuse, misuse, and addiction.
Using a benzodiazepine, such as chlordiazepoxide, for some time, especially at higher doses, may cause physical dependence. This is when your body and brain rely on the medication. Chlordiazepoxide should not be abruptly stopped after continued use. Instead, the healthcare provider will instruct the person on how to slowly taper off the drug safely to avoid withdrawal symptoms.
It is also occasionally prescribed to treat irritable bowel syndrome (IBS), among other diagnoses. The medication works by decreasing abnormal electrical activity in the brain.
While currently available only under its generic name in the U.S., chlordiazepoxide is available as an orally administered (taken by mouth) tablet.
What Is Chlordiazepoxide Used For?
The FDA approved chlordiazepoxide to:
Brand Name(s): Librium (no longer available in the U.S.
Drug Availability: Prescription
Therapeutic Classification: Benzodiazepine
Available Generically: Yes
Controlled Substance: Yes
Administration Route: Oral
Active Ingredient: Chlordiazepoxide
Dosage Form(s): Capsule
Treat anxiety disordersTreat preoperative anxietyTreat withdrawal symptoms of acute alcoholism
Chlordiazepoxide is not used to treat anxiety associated with the stress of everyday life. Chlordiazepoxide is approved for short-term use and has not been studied for more than four months. The healthcare provider will periodically determine the need to continue prescribing chlordiazepoxide.
Chlordiazepoxide for anxiety or alcohol withdrawal is a single-ingredient medication. It is also available as several combination medications.
Chlordiazepoxide/amitriptyline (an antidepressant and nerve pain medication) treats moderate to severe depression with anxiety. Chlordiazepoxide/clidinium treats IBS and peptic ulcer disease.
This article will only focus on the single-ingredient product chlordiazepoxide.
How to Take Chlordiazepoxide
If you are prescribed chlordiazepoxide, adhere to the following:
Read the prescription label and the medication guide that comes with your prescription. Use chlordiazepoxide exactly as directed by your healthcare provider. Follow the directions on the prescription label. Do not take more chlordiazepoxide than prescribed or use it for longer than prescribed. Instead, tell your healthcare provider if you feel the urge to take additional chlordiazepoxide. Do not share chlordiazepoxide with anyone else, even if they have the same symptoms. Taking chlordiazepoxide inappropriately can cause addiction, overdose, or death. Do not sell or give away chlordiazepoxide. It is against the law to do so. Chlordiazepoxide is usually taken for less than four months. Do not stop taking chlordiazepoxide abruptly. Ask your healthcare provider how to safely and slowly stop taking chlordiazepoxide. Life-threatening withdrawal symptoms can occur if you stop taking chlordiazepoxide suddenly after you have been taking it for a period of time.
Ask your healthcare provider if you have any questions or concerns about chlordiazepoxide.
Storage
Store at room temperature, away from heat, direct light, and moisture. Do not store in a bathroom. Keep this medication in its original labeled container and out of the reach and out of sight of children and pets.
Store the medicine where no one can use it improperly, including family members and visitors. Keep the bottle tightly closed when not in use.
Off-Label Uses
Sometimes chlordiazepoxide is used off-label for indications that are not FDA-approved. Healthcare providers may prescribe chlordiazepoxide to people:
With premenstrual symptoms With catatonia associated with schizophrenia With post-traumatic stress disorder
What Are the Side Effects of Chlordiazepoxide?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Like other medications, chlordiazepoxide can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.
Common Side Effects
Chlordiazepoxide can cause drowsiness, weakness, and confusion, especially in older adults (65 and older) or people in a weakened state. This can lead to accidents, falls, and fractures.
Other common side effects of chlordiazepoxide are:
Appetite changes Bladder problems Constipation Decreased interest in sex Double vision Impaired coordination Involuntary muscle contractions Irregular periods Irritability Memory and concentration problems Nausea Skin eruptions Slurred speech Swelling Tiredness
Severe Side Effects
Chlordiazepoxide has a black box warning, which is the strongest warning required by the FDA.
Using a benzodiazepine such as chlordiazepoxide, along with an opioid (narcotic) pain medication, may cause profound sedation (a very deep sleep where it is hard to wake up), respiratory depression (breathing may slow or stop), coma, and death. Benzodiazepines and opioids should only be prescribed together when there is no other option available for treatment. When prescribed together, the drugs should be prescribed at the lowest effective dose for the shortest possible period of time, and the person should be closely monitored.
Chlordiazepoxide is a controlled substance and has the potential for abuse, misuse, and addiction. This can lead to overdose or death. Often, misuse of benzodiazepines such as chlordiazepoxide involves other medications, alcohol, and/or illegal drugs. Therefore, before prescribing chlordiazepoxide, the healthcare provider will assess the person’s risk for abuse, misuse, and addiction.
Using a benzodiazepine, such as chlordiazepoxide, for a period of time, especially at higher doses, may cause physical dependence. This is when your body and brain rely on the medication. Chlordiazepoxide should not be abruptly stopped after continued use. The healthcare provider will instruct the person on how to slowly taper off the drug safely to avoid withdrawal symptoms.
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.
Serious side effects and their symptoms can include the following:
Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, difficulty breathing, and require emergency medical attention. Respiratory depression: Slow heart rate, slowed breathing, blue lips, difficulty waking up Suicidal thoughts or behavior: Be alert to (and family and caregivers should be alert to) thoughts of hurting yourself, changes in mood and behavior Abuse/dependence: Tell your healthcare provider if you are feeling an urge to use this medicine. Seizures Falls/fainting Withdrawal symptoms if the drug is stopped abruptly: Ask your healthcare provider before stopping this medication. They will give you instructions on how to slowly taper off the drug.
Long-Term Side Effects
Chlordiazepoxide is recommended for short-term use and generally should not be used for longer than four months because it has not been studied for long-term effectiveness. As stated in the black box warning, taking chlordiazepoxide for a longer period of time may increase the risk of physical dependence and withdrawal. Some withdrawal symptoms can last up to a year, or even longer.
Chlordiazepoxide should never be stopped abruptly after continued use. Instead, the healthcare provider will give the person instructions on how to slowly and safely taper off the drug.
Dosage: How Much Chlordiazepoxide Should I Take?
Modifications
Users should be aware of the following before beginning chlordiazepoxide:
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (capsules): For anxiety: Adults—5 to 25 milligrams (mg) three or four times a day. Older adults—5 milligrams (mg) two to four times a day. Children 6 years of age and older—At first, 5 milligrams (mg) two to four times a day. Your doctor may increase your dose if needed. Children younger than 6 years of age—Use and dose must be determined by your doctor. For apprehension and anxiety before a surgery: Adults—5 to 10 milligrams (mg) three or four times a day, taken several days before the surgery. Children—Use and dose must be determined by your doctor. For symptoms of alcohol withdrawal: Adults—At first, 50 to 100 milligrams (mg). The dose may be repeated until agitation is controlled. However, the dose is usually not more than 300 mg per day. Children—Use and dose must be determined by your doctor.
Older adults: The American Geriatrics Society publishes a list called the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Chlordiazepoxide is included on this list. The guidelines state that older adults have an increased sensitivity to longer-acting benzodiazepines, like chlordiazepoxide.
They also may not process the medication, which could cause the medicine to build up in the system, leading to more side effects. In older adults, benzodiazepines increase the risk of cognitive impairment (trouble with memory, learning, and concentration), delirium (confused thinking), falls, fractures, and car accidents.
The guidelines state that benzodiazepines should not be used to treat insomnia, agitation, or delirium in older adults. Older adults (or those in a weakened state) who take chlordiazepoxide will generally be prescribed the lowest effective dose for the shortest period of time and will be closely monitored.
Children: The prescribing information states that chlordiazepoxide should not be used in children under 6 years old. Because children can have an unpredictable response to this medicine, treatment should start with the lowest dose.
People with kidney or liver problems: People with kidney or liver problems may need to use chlordiazepoxide with caution, or not at all, depending on the severity of their condition. The healthcare provider will determine if chlordiazepoxide is safe to use.
Pregnant people: Chlordiazepoxide is not used in pregnant women because it can harm the unborn baby. People who already take chlordiazepoxide and find out they are pregnant should contact their healthcare provider immediately.
Nursing people: Because there is no information available on the use of chlordiazepoxide in nursing people, individuals who are nursing should consult their healthcare provider.
Missed Dose
If you miss a dose of chlordiazepoxide, take it as soon as you can. However, if it is almost time for the next dose, skip the missed dose. Do not take extra medicine to try to make up for a missed dose.
Overdose: What Happens If I Take Too Much Chlordiazepoxide?
Always follow the instructions for taking chlordiazepoxide. A chlordiazepoxide overdose can cause death if taken with alcohol, opioid pain medicine, or other medicines that cause drowsiness/slow breathing.
Symptoms associated with the potential overdose of chlordiazepoxide include dry mouth, blurry vision, decreased urination, constipation, weakness, excess sleepiness, confusion, and loss of consciousness.
Precautions
What Are Reasons I Shouldn’t Take Chlordiazepoxide?
Chlordiazepoxide is not appropriate for everyone. You should not take this medication if you are allergic to chlordiazepoxide or any of the inactive ingredients in chlordiazepoxide.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
This medicine may cause some people, especially older persons, to become drowsy, dizzy, lightheaded, clumsy or unsteady, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to think or see well.
This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates (used for seizures); muscle relaxants; or anesthetics (numbing medicines), including some dental anesthetics. This effect may last for a few days after you stop taking this medicine. Check with your doctor before taking any of the above while you are using this medicine.
If you develop any unusual and strange thoughts or behavior while you are taking chlordiazepoxide, be sure to discuss it with your doctor. Some changes that have occurred in people taking this medicine are like those seen in people who drink alcohol and then act in a manner that is not normal. Other changes may be more unusual and extreme, such as confusion, worsening of depression, hallucinations (seeing, hearing, or feeling things that are not there), suicidal thoughts, and unusual excitement, nervousness, or irritability.
Do not stop taking it without checking with your doctor first. . Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a worsening of your condition and reduce the possibility of withdrawal symptoms, such as convulsions (seizures), stomach or muscle cramps, tremors, or unusual behavior.
This medicine is for short-term use only (usually 7 to 10 days). If your condition does not improve or if it becomes worse, check with your doctor.
Chlordiazepoxide may be prescribed with caution in some people only if the healthcare provider determines it is safe. This includes:
Older adults Adults in a weakened state People with kidney or liver problems People with lung problems or sleep apnea People with central nervous system (CNS) depression (due to other medications or alcohol) People who drink alcohol People who have a history of substance use disorder (alcohol or drugs) People with a history of seizures People with depression People with porphyria (a group of disorders caused by an excess buildup of porphyrin)
What Other Medications May Interact With Chlordiazepoxide?
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter (OTC) medicines, and vitamins or supplements. While taking chlordiazepoxide, do not start any new medications without approval from your healthcare provider. Some drug interactions include:
Alcohol Anti-seizure medications such as Dilantin (phenytoin) or phenobarbital Certain antidepressants such as Cymbalta (duloxetine) or Zoloft (sertraline) Marijuana Muscle relaxants such as Flexeril (cyclobenzaprine) or Skelaxin (metaxalone) Opioid pain medications such as oxycodone or Ultram (tramadol) Other benzodiazepine such as Valium (diazepam) or Xanax (alprazolam) Sleeping medications such as Ambien (zolpidem) or Sonata (zaleplon) Triptans used for migraines such as Imitrex (sumatriptan) or Maxalt (rizatriptan)
This is not a full list of drug interactions. Other drug interactions may occur with chlordiazepoxide. Consult your healthcare provider for a complete list of drug interactions.
What Medications Are Similar?
Chlordiazepoxide is a benzodiazepine used for anxiety.
Other examples of benzodiazepines include:
Ativan (lorazepam) Klonopin (clonazepam) Valium (diazepam) Xanax (alprazolam)
Benzodiazepines are not usually the first choice of treatment for anxiety because of their side effects and potential for abuse and dependence.
However, it’s important to know that while selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered first-line by most guidelines, benzodiazepines can still be used when an antidepressant is started since it takes a few weeks for anxiolytic effects to kick in.
Certain antidepressants can even worsen anxiety initially, so benzodiazepines can be used for the first two-three weeks an antidepressant is being titrated to cover subsequent symptomatic anxiety.
Examples of SSRI antidepressants include:
Celexa (citalopram) Lexapro (escitalopram) Paxil (paroxetine) Prozac (fluoxetine) Zoloft (sertraline)
Another alternative to an SSRI antidepressant, which is often used as a first-choice treatment for anxiety, is a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant.
Examples include:
Cymbalta (duloxetine) Effexor XR (venlafaxine) Pristiq (desvenlafaxine)
For anxiety, medication is often one part of a comprehensive treatment plan that may also include other methods such as therapy, yoga, and meditation.
This list is a list of drugs also prescribed for anxiety. It is NOT a list of drugs recommended to take with chlordiazepoxide. Ask your pharmacist or a healthcare provider if you have questions.
How Can I Stay Healthy While Taking Chlordiazepoxide?
While taking chlordiazepoxide, do not start any other new medications unless approved by your healthcare provider. This includes prescription and OTC drugs as well as vitamins or supplements.
Chlordiazepoxide can make you very drowsy or dizzy. Do not drive or operate machinery until you know how chlordiazepoxide affects you. You may also be more likely to fall or faint while taking this medicine. Avoid alcohol, marijuana, and any medications that can make you feel tired or dizzy when taking chlordiazepoxide.
Stopping chlordiazepoxide too quickly can cause life-threatening withdrawal symptoms. Some symptoms can last up to a year, or even longer. When it is time to stop taking chlordiazepoxide, your healthcare provider will give you a schedule to help you stop taking the drug slowly and safely. Follow your healthcare provider’s instructions carefully.
