Chlordiazepoxide oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of chlordiazepoxide.
Drugs List
Therapeutic Indications
Uses
Acute alcohol withdrawal
Anxiety state (severe) - short term relief
Insomnia
Muscle spasms
Dosage
Adults
Anxiety
Initial: 10mg two to three times a day. Increased to 30mg a day, in divided doses.
For severe symptoms 20mg two to four times day.
Maximum dose: 100mg a day, given in divided doses.
Treatment should not exceed four weeks on maximum dose, including tapering off process.
Insomnia associated with anxiety
10mg to 30mg to be taken at bedtime.
Treatment should not exceed four weeks on maximum dose, including tapering off process.
Muscle Spasm
10mg to 30mg a day, given in divided doses.
Symptomatic Relief of Acute Alcohol Withdrawal
25mg to 100mg. Dose may be repeated in 2 to 4 hours, if considered necessary.
The following alternative dosing schedule may be suitable:
10mg to 50mg in divided doses of four times a day. For the first two days an extra 10mg to 40mg may be given when required.
Doses should be gradually reduced over a period of seven to ten days.
Maximum daily dose should not exceed 250mg.
Elderly
Doses should not exceed half the recommended dose for adults.
Patients with Renal Impairment
Doses should not exceed half the recommended dose for adults.
The Renal Drug Handbook suggests patients with a glomerular filtration rate of less than 10ml/minute should be given a 50% dose reduction of the recommended adult dose.
Patients with Hepatic Impairment
Doses should not exceed half the recommended dose for adults.
Additional Dosage Information
Debilitated patients
Doses should not exceed half the recommended dose for adults.
Patients who have taken benzodiazepines for a prolonged time may require a longer period during which doses are reduced.
Contraindications
Children under 18 years
Breastfeeding
Cerebellar ataxia
Chronic psychosis
Galactosaemia
Myasthenia gravis
Obsessional states
Phobic states
Pregnancy
Respiratory depression
Severe hepatic impairment
Severe respiratory impairment
Sleep apnoea
Spinal ataxia
Precautions and Warnings
Debilitation
Elderly
Females of childbearing potential
Fertile males
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of alcohol abuse
History of drug misuse
Lactose intolerance
Organic brain syndrome
Personality disorder
Renal impairment
Respiratory impairment
Advise patient ability to drive or operate machinery may be impaired
Advise patient not to drive until they know how the medicine affects them
Advise patient this medicine may be subject to driving restrictions
Contains lactose
Prolonged or excessive use may result in dependence
Refer women considering pregnancy for specialist advice and monitoring
Amnesia may occur
Discontinue if psychiatric disturbances develop
Psychological adjustment may be impaired in loss or bereavement
Tolerance may develop with continued use
Avoid abrupt withdrawal
Advise patient to seek advice at first indications of pregnancy
Maintain treatment at the lowest effective dose
Reduce dose in elderly
Not recommended for use longer than 4 weeks
Only recommended for short term use
Advise patient to avoid alcohol during treatment
Advise that effects are potentiated by CNS depressants (including alcohol)
Female: Contraception required during and for 7 months after treatment
Male & female: Ensure adequate contraception during treatment
Male: Contraception required during and for 4 months after treatment
Advise patient of increased risk of falls
Advise patient on possible rebound phenomena on withdrawal
Do not use benzodiazepines alone to treat depression or anxiety associated with depression.
Pregnancy and Lactation
Pregnancy
Chlordiazepoxide is contraindicated during pregnancy.
The manufacturer does not recommend using chlordiazepoxide during pregnancy, particularly during the first and last trimester unless the benefit to the mother outweighs the potential risk. At the time of writing there is limited published information regarding the use of chlordiazepoxide during pregnancy. Chlordiazepoxide is known to cross the placenta.
Animal studies have shown reproductive toxicity. If chlordiazepoxide has been administered at high doses during the late phase of pregnancy or during labour, neonates can suffer effects such as hypothermia, irregularities in foetal heart rate and hypotonia, poor-sucking and moderate respiratory depression. Infants may have physical dependence and be at some risk for withdrawal symptoms in the postnatal period.
Lactation
Chlordiazepoxide is contraindicated during breastfeeding.
Chlordiazepoxide is found in breast milk. The manufacturer does not recommend breastfeeding whilst taking chlordiazepoxide.
Side Effects
Amnesia
Ataxia
Blood dyscrasias
Changes in libido
Confusion
Dependence
Depression
Dizziness
Drowsiness
Dysarthria
Excitement (paradoxical)
Gastro-intestinal disturbances
Headache
Hypotension
Incontinence
Increased hostility and aggression (paradoxical)
Jaundice
Muscle weakness
Rash
Salivation changes
Sedation
Suicidal tendencies
Unsteady gait
Urinary retention
Vertigo
Visual disturbances
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: August 2019
Reference Sources
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Librium capsules 5mg. Mylan Products Ltd. Revised April 2022.
Summary of Product Characteristics: Librium capsules 10mg. Mylan Products Ltd. Revised April 2022.
The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.
NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 06 July 2019
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