chlordiazepoxide (Rx)

Brand and Other Names:Librium
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule: Schedule IV

  • 5mg
  • 10mg
  • 25mg
more...

Anxiety

Mild/moderate: 5-10 mg PO q6-8hr

Severe: 20-25 mg PO q6-8hr

Preoperative Apprehension & Anxiety

5-10 mg PO q6-8hr

Geriatric Dosing

Not drug of choice in elderly because of prolonged sedation and increased risk of falls/fractures

Anxiety

  • Lower initial dose: 5 mg PO q6-12hr; adjust gradually based on response and incidence of adverse effects

Dosing considerations

  • Adjust for renal impairment; administer 50% of recommended dose if CrCl <10 mL/min

Dosing Modifications

Renal impairment

  • CrCl <10 mL/min: 50% of recommended dose
  • CrCl >10 mL/min: Dose adjustment not necessary (monitor)

Hepatic impairment

  • Not studied

Dosage Forms & Strengths

capsule: Schedule IV

  • 5mg
  • 10mg
  • 25mg
more...

Anxiety

<6 years: Safety and efficacy not established

>6 years: 5 mg PO BID/QID; may increase dose to 10 mg PO BID/TID if necessary

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Interactions

Interaction Checker

and chlordiazepoxide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Ataxia

            Drowsiness

            Memory impairment

            Sedation

            Muscle weakness

            Rash

            Decreased libido

            Menstrual disorders

            Xerostomia

            Salivation decreased

            Increased/decreased appetite

            Weight gain/loss

            Micturition difficulties

            1-10%

            Confusion

            Dizziness

            Disinhibition

            Akathisia

            Dermatitis

            Hypotension

            Salivation increased

            Sexual dysfunction

            Incontinence

            Rigidity

            Tremor

            Muscle cramps

            Tinnitus

            Nasal congestion

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            Warnings

            Black Box Warnings

            Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation

            Contraindications

            Documented hypersensitivity to drug or component of the formulation

            Cautions

            Patient should be observed for up to 3 hours following administration

            Anterograde amnesia associated with treatment

            Use caution in renal and hepatic impairment

            Use caution in respiratory disease (COPD), sleep apnea, porphyria, open-angle glaucoma (questionable), depression, suicidal ideation, impaired gag reflex

            May impair ability to perform hazardous tasks

            Paradoxical reactions, including hyperactive or aggressive behavior, reported

            Use caution in patients with depression, especially if suicidal risk present

            Ataxia and oversadation may occur in the elderly and debilitated patients; there also increased risk of falls

            Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Enters breast milk/not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through the GABA receptor system. Increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane

            Absorption

            Bioavailability: Slow and erratic following IM admin

            Onset: 1-5 min (IV)

            Duration: 15-60 min (IV)

            Plasma peak time: Within 2 hr

            Distribution

            Protein bound: 90-98%

            Vd: 3.3 L/kg

            Metabolism

            Metabolites: Demoxepam, desmethylchlordiazepoxide, desmethyldiazepam, oxazepam

            Elimination

            Half-life: 6-25 hr (normal liver and renal function); 5-30 hr (end-stage renal disease); 30-63 hr (liver cirrhosis)

            Excretion: Urine

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            Administration

            IV Incompatibilities

            Solution: NS(?)

            Y-site: Cefepime

            IV Compatibilities

            Solution: D5W, LR

            Y-site: Heparin, hydrocortisone Na-succinate, KCl, vitamin B/C

            IV Administration

            Preferred over IM due to erratic IM absorption

            Slow IVP over >1 min: Rapid administration can cause hypotension, slow respiration, bradycardia

            Have airway support available until effects of IV administration known

            Patient should be observed for up to 3 hr following administration

            Monitor respiration q5-15min after use and before each repeated dose

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.