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Chlordiazepoxide

Chlordiazepoxide

Definition

Chlordiazepoxide is used for the treatment of anxiety. It is a member of the benzodiazepine family of compounds, which slow the central nervous system in order to ease tension or nervousness. In the United States, it is sold under the trade name of Librium.

Purpose

Chlordiazepoxide is used for the short-term relief of symptoms of anxiety and management of anxiety disorders. It is also used for treating symptoms of withdrawal from acute alcoholism and alcoholic intoxication.

Description

Chlordiazepoxide is useful when treating anxiety for short periods of time. It has sedative properties that are useful for brief periods of use. It is occasionally used to stimulate appetites and is a weak analgesic. The precise mechanism of action is not known. Several hours are needed for peak levels of the drug to be achieved. Chlordiazepoxide is available in 5-, 10-, and 25-mg capsules.

Recommended dosage

Recommended dosage varies with diagnosis . The lowest possible dosage that provides relief from symptoms should be used as the drug has a high potential to cause physiological and psychological dependence. When used in adults for the treatment of moderate anxiety, the usual oral dosage is 510 mg three or four times per day. When used for the treatment of more severe anxiety and anxiety disorders , the usual oral dosage is 2025 mg three or four times per day. When used by older persons, or to relieve symptoms of preoperative apprehension or anxiety, the usual oral dosage is 5 mg two to four times per day. If used as a preoperative medication, the usual dosage is 50100 mg via intramuscular (IM) injection. When used to treat symptoms of acute alcoholism, the usual initial oral dosage is 50100 mg, repeated as needed until agitation is adequately controlled. The recommended maximum dosage is 300 mg per day. The usual dosage for children is 5 mg two to four times per day.

Precautions

Persons with suicidal tendencies should be closely monitored, as chlordiazepoxide may lower the threshold for action and attempting suicide . The drug has a high potential to cause physiological or psychological dependence.

Side effects

Other than physiological and psychological dependence, few adverse effects have been reported. The most commonly reported include drowsiness, confusion, and difficulty in moving. These are most common among older persons. Occasionally, transient loss of consciousness has been reported.

Other adverse effects include edema (abnormal accumulation of fluid in bodily tissues), minor menstrual irregularities, nausea, constipation and, infrequently, changes in libido (sex drive). Also, it may impair mental or physical skills needed to perform complex motor tasks. For this reason, persons using this drug are advised not to drive automobiles or operate machinery.

Interactions

Chlordiazepoxide may increase the effect of alcohol or other substances that depress central nervous system functions. For this reason, they should not be used at the same time. A small number of reports of interaction with oral anticoagulants have been received, and it may exacerbate porphyriaa group of inherited disorders in which there is abnormally increased production of substances called porphyrins.

See also Addiction; Alcohol and related disorders; Anti-anxiety drugs and abuse-related disorders

Resources

BOOKS

Adams, Michael and Norman Holland. Core Concepts in Pharmacology. Philadelphia: Lippincott-Raven, 1998.

Albers, Lawrence J., M.D., Rhoda K. Hahn, M.D., and Christopher Reist, M.D. Handbook of Psychiatric Drugs. 20012002. Laguna Hills, CA: Current Clinical Strategies Publishing, 2001.

Foreman, John C. and Torben Johansen. Textbook of Receptor Pharmacology. 2nd ed. Boca Raton, FL: CRC Press, 2002.

Page, Clive P., and Michael Murphy. Integrated Pharmacology. St. Louis: Mosby-Year Book, 2002.

Von Boxtel, Chris J., Budiono Santoso, and I. Ralph Edwards. Drug Benefits and Risks: International Textbook of Clinical Pharmacology. New York: John Wiley & Sons, 2001.

PERIODICALS

Alexopoulou A., A. Michael, and S. P. Dourakis. "Acute thrombocytopenic purpura in a patient treated with chlordiazepoxide and clidinium." Archives of Internal Medicine 161, no. 14 (2001): 1778-1779.

ORGANIZATIONS

American Academy of Clinical Toxicology. 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105-8820. Telephone: (717) 558-7750. FAX: (717) 558-7845. Web site: <http://www.clintox.org/index.html>.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone: (913) 906-6000. Web site: <http://www.aafp.org/>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org/>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax: (202) 682-6850. Web site: <http://www.psych.org/>.

American Society for Clinical Pharmacology and Therapeutics. 528 North Washington Street, Alexandria, VA 22314. Telephone: (703) 836-6981. Fax: (703) 836-5223.

American Society for Pharmacology and Experimental Therapeutics. 9650 Rockville Pike, Bethesda, MD 20814-3995. Telephone: (301) 530-7060. Fax: (301) 530-7061. Web site: <http://www.aspet.org/>.

L. Fleming Fallon, Jr., M.D., Dr.P.H.

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Chlordiazepoxide

CHLORDIAZEPOXIDE

Chlordiazepoxide (brand name Librium) is a member of the Benzodiazepine family of drugs currently used to treat insomnia, anxiety, muscle spasms, and some forms of epilepsy. It was the first benzodiazepine to be used in clinical practice in the 1960s, as an alternative to Phenobarbital or Meprobamate, in treating psychoneuroses, anxiety, and tension. Its advantage over Barbiturates and other central nervous system depressants is that it is less toxic, especially after an overdose.

In addition to the previously mentioned uses, chlordiazepoxide is frequently used to treat the seizures or Delirium Tremens (DTs) that appear during alcohol withdrawal. In the late 1990s, Dr. Michael Mayo-Smith conducted a meta-analysis to determine if benzodiazepines effectively prevent delirium in patients experiencing DTs. Although benzodiazepines were shown to be effective, this study was not conclusive since chlordiazepoxide was the only benzodiazepine tested, and further testing is needed on other benzodiazepines before an overall claim can be made (Johnson et al., 1997).

BIBLIOGRAPHY

Johnson, J. R., et al. (1997). Pharmacologic treatment of alcohol withdrawal. JAMA, The Journal of the American Medical Association, 278, 1317-1319.

Chlordiazepoxide and clidinium (2000). USP DI Volume II Advice for the Patient: Drug Information in Lay Language, 93.

Scott E. Lukas

Revised by Rebecca Marlow-Ferguson

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chlordiazepoxide

chlordiazepoxide (klor-dy-az-i-pok-syd) n. a benzodiazepine with muscle relaxant properties, administered by mouth to relieve tension, fear, and anxiety. Trade names:. Librium,. Tropium.

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Chlordiazepoxide

Chlordiazepoxide

Definition

Purpose

Description

Recommended dosage

Precautions

Side effects

Interactions

Resources

Definition

Chlordiazepoxide is used for the treatment of anxiety and also to control agitation brought on by alcohol withdrawal. It is a member of the benzodiaze-pine family of compounds, which slow the central nervous system to ease tension or nervousness. In the United States, it is sold under the trade names of Librium® and Librax®, and as Limbitrol® when in combination with another drug, amitriptyline.

Purpose

Chlordiazepoxide is used for the short-term relief of symptoms of anxiety and the management of anxiety disorders. It is also used for treating symptoms of withdrawal from acute alcoholism and alcoholic intoxication. One drug therapy combines this drug with amitriptyline to treat depression that accompanies anxiety or tension.

Description

Chlordiazepoxide is useful when treating anxiety for short periods of time. It has sedative properties that are useful for these brief periods of use. In addition, it is occasionally used to stimulate appetites and is a weak analgesic. Its precise mechanism of action is unknown, and several hours are needed for peak levels of the drug to be achieved. Chlordiazepoxide is available in 5-, 10-, and 25-mg capsules.

Recommended dosage

The recommended dosage varies with diagnosis. The lowest possible dosage that provides relief from symptoms should be used as the drug has a high potential to cause physiological and psychological dependence. When used in adults for the treatment of moderate anxiety, the usual oral dosage is 5-10 mg three or four times per day. When used for the treatment of more severe anxiety and anxiety disorders , the usual oral dosage is 20-25 mg three or four times per day. When used by older persons, or to relieve symptoms of preoperative apprehension or anxiety, the usual oral dosage is 5 mg two to four times per day. If used as a preoperative medication, the usual dosage is 50-100 mg via intramuscular (IM) injection. When used to treat symptoms of acute alcoholism, the usual initial oral dosage is 50-100 mg, repeated as needed until agitation is adequately controlled. The recommended maximum dosage is 300 mg per day. The usual dosage for children is 5 mg two to four times per day.

Precautions

Persons with suicidal tendencies should be closely monitored, as chlordiazepoxide may lower the threshold for action in attempting suicide . The drug has a high potential to cause physiological or psychological dependence.

In the last few years, there have been cases in which pills originating overseas but sold over the counter in the United States have contained chlordiazepoxide. A case from 2001 involved ingredients shipped from China for pill manufacture in California, and another case from 2006 involved pills from Brazil. Both resulted in warnings to consumers by the U.S. Food and Drug Administration (FDA). In the more recent case, the products—marketed as dietary/weight loss supplements under the names Emagrece Sim and Herbathin—were available for sale over the Internet and imported and distributed by a Florida company. Because of the serious possibility of interactions with medication and vitamins and the lack of quality control, taking these pills can be dangerous. The FDA advises consumers who have these products to return them to the distributor.

Side effects

Other than physiological and psychological dependence, few adverse effects have been reported. The most commonly reported include drowsiness, confusion, and movement difficulties. These are most common among older persons. Occasionally, transient loss of consciousness has been reported.

Other adverse effects include edema (abnormal accumulation of fluid in bodily tissues), minor menstrual irregularities, nausea, constipation and, infrequently, changes in libido (sex drive). Also, chlordiazepoxide may impair mental or physical skills needed to perform complex motor tasks. For this reason, persons using this drug are advised not to drive automobiles or operate machinery.

This drug is known to increase the risk birth defects in the fetus when taken during the first three months of pregnancy, and it also can cause dependency in the developing baby that can result in withdrawal symptoms following birth. Chlordiazepoxide passes into the breast milk and can cause breathing trouble and slow heartbeat in babies.

Interactions

Chlordiazepoxide may increase the effect of alcohol or other substances that depress central nervous

KEY TERMS

Analgesic —A substance that provides relief from pain.

Edema —Abnormal accumulation of fluid in the interstitial spaces of bodily tissue.

Libido —Psychic energy or instinctual drive associated with sexual desire, pleasure, or creativity.

Porphyria —A group of disorders that arise from changes in the metabolism of porphyrin, a naturally occurring compound in the body, and that are characterized by acute abdominal pain and neurological problems.

Porphyrin —Any iron- or magnesium-free pyrrole derivative occurring in many plant and animal tissues.

system functions. For this reason, they should not be used at the same time. A small number of reports of interaction with oral anticoagulants have been received, and it may exacerbate porphyria, which is a group of inherited disorders in which there is abnormally increased production of substances called porphyrins. Any medications, prescribed or over the counter, should be brought to the attention of a doctor or pharmacist.

See alsoAddiction; Alcohol and related disorders; Anti-anxiety drugs and abuse-related disorders; Pharmacotherapy.

Resources

BOOKS

Adams, Michael, and Norman Holland. Core Concepts in Pharmacology. Philadelphia: Lippincott-Raven, 1998.

Albers, Lawrence J., MD, Rhoda K. Hahn, MD, and Christopher Reist, MD. Handbook of Psychiatric Drugs. 2001–2002. Laguna Hills, CA: Current Clinical Strategies Publishing, 2001.

Foreman, John C., and Torben Johansen. Textbook of Receptor Pharmacology, 2nd ed. Boca Raton, FL: CRC Press, 2002.

Page, Clive P., and Michael Murphy. Integrated Pharmacology. St. Louis: Mosby-Year Book, 2002.

Von Boxtel, Chris J., Budiono Santoso, and I. Ralph Edwards. Drug Benefits and Risks: International Textbook of Clinical Pharmacology. New York: John Wiley & Sons, 2001.

PERIODICALS

Alexopoulou A., A. Michael, and S. P. Dourakis. “Acute Thrombocytopenic Purpura in a Patient Treated with Chlordiazepoxide and Clidinium.” Archives of Internal Medicine 161.14 (2001): 1778–79.

ORGANIZATIONS

American Academy of Clinical Toxicology. 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105-8820. Telephone: (717) 558-7750. Fax: (717) 558-7845. Web site: <http://www.clintox.org/index.html>.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Telephone: (913) 906-6000. Web site: <http://www.aafp.org>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax: (202) 682-6850. Web site: <http://www.psych.org>.

American Society for Clinical Pharmacology and Therapeutics. 528 North Washington Street, Alexandria, VA 22314. Telephone: (703) 836-6981. Fax: (703) 836-5223. Web site: <http://www.ascpt.org>.

American Society for Pharmacology and Experimental Therapeutics. 9650 Rockville Pike, Bethesda, MD 20814-3995. Telephone: (301) 530-7060. Fax: (301) 530-7061. Web site: <http://www.aspet.org>.

OTHER

National Library of Medicine. National Institutes of Health. “Chlordiazepoxide.” <http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682078.html>.

National Library of Medicine. National Institutes of Health. “Chlordiazepoxide and Amitryptiline.” <http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202129.html>.

U.S. Food and Drug Administration. “FDA News: FDA Warns Consumers About Brazilian Diet pills Found to Contain Active Drug Ingredients. Emagrece Sim and Herbathin Dietary Supplements May be Harmful.” (2006). <http://www.fda.gov/bbs/topics/news/2006/NEW01298.html>.

U.S. Food and Drug Administration. Label Information for Limbitrol®. <http://www.fda.gov/cder/foi/label/2001/16949S33lbl.pdf>.

L. Fleming Fallon, Jr.,MD,Dr.P.H.

Emily Jane Willingham, PhD

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"Chlordiazepoxide." The Gale Encyclopedia of Mental Health. . Encyclopedia.com. (November 15, 2018). https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/chlordiazepoxide

"Chlordiazepoxide." The Gale Encyclopedia of Mental Health. . Retrieved November 15, 2018 from Encyclopedia.com: https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/chlordiazepoxide

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Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

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