Chlordiazepoxide
LIBRIUM
Pronunciation: klor-dye-az-e-POX-ide
“Liberty Cooler dies of pox”
“dies of pox” → just a sound-alike for diazepox; unrelated to medication properties
approved for alcohol withdrawal
hot pink → benzo theme
What it isLong-acting benzodiazepine; alcohol withdrawal and anxiety.
Why this oneActive metabolites self-taper, which is why it is the classic agent for a fixed-dose withdrawal regimen.
What limits itAccumulates in the elderly and in liver disease; lorazepam is preferred there. Dependence as for the class.
FDA-approved for
- anxiety (1960)
- alcohol withdrawal (~1960)
FDA label
Read the full label on DailyMed ↗
BOXED WARNING Concomitant use with opioids can cause profound sedation, respiratory depression, coma and death; benzodiazepines carry risks of abuse, misuse and addiction, and of physical dependence with life-threatening withdrawal on abrupt discontinuation or rapid dose reduction — taper gradually.
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Mild to moderate anxiety disorder / symptoms of anxiety | Adults | 5 mg TID–QID | 5–10 mg TID–QID | Not stated |
| Severe anxiety disorder / symptoms of anxiety | Adults | 20 mg TID–QID | 20–25 mg TID–QID | Not stated |
| Anxiety | Geriatric patients, or debilitating disease | 5 mg BID | 5 mg BID–QID | Not stated |
| Preoperative apprehension and anxiety | Adults | 5 mg PO TID–QID on days preceding surgery | 5–10 mg PO TID–QID on days preceding surgery; if used as preoperative medication, 50–100 mg IM 1 hour before surgery | Not stated |
| Withdrawal symptoms of acute alcoholism | Adults | 50–100 mg PO initially, repeated as needed until agitation is controlled (parenteral form usually used initially) | Reduce to maintenance level once agitation is controlled | 300 mg/day |
| Anxiety | Children ≥6 y | 5 mg BID | 5 mg BID–QID; may be increased in some patients to 10 mg BID–TID | Not stated |
Renal Undefined
Hepatic Undefined
Acute alcohol withdrawal: repeat the oral dose as needed until agitation is controlled, up to 300 mg/day, then reduce to maintenance.
Instructions
- Individualize the dose to the diagnosis and patient response; initiate at the lowest dose and increase as required.
- Discontinue by gradual taper to reduce the risk of withdrawal reactions. If withdrawal reactions develop, pause the taper or return to the previous dose level, then decrease more slowly.
- Not recommended in children under 6 years of age (limited clinical experience).
- With protracted treatment, periodic blood counts and liver function tests are advisable.
Available strengths
- cap 5, 10, 25 mg
Cautions
- Concomitant opioid use — profound sedation, respiratory depression, coma and death; reserve for patients without adequate alternatives, limit dose and duration, and monitor for sedation and respiratory depression.
- Abuse, misuse and addiction, which can lead to overdose or death — assess risk before prescribing and throughout treatment; risk is increased with concomitant alcohol, other medications or illicit substances.
- Physical dependence and withdrawal — risk rises with longer duration and higher daily dose; abrupt discontinuation or rapid reduction may precipitate life-threatening acute withdrawal.
- Drowsiness, ataxia and confusion, particularly in elderly and debilitated patients — usually avoidable with dose adjustment but reported even at lower doses.
- Blood dyscrasias (including agranulocytosis), jaundice and hepatic dysfunction reported — monitor CBC and liver function with protracted therapy.
Adverse reactions
- Drowsiness, ataxia, confusion — especially in elderly and debilitated patients.
- Syncope (a few instances).
- Skin eruptions, edema, minor menstrual irregularities, nausea, constipation.
- Extrapyramidal symptoms; increased or decreased libido.
- EEG changes (low-voltage fast activity) during and after treatment.
- Blood dyscrasias including agranulocytosis; jaundice and hepatic dysfunction (occasional).
Pregnancy Undefined
Lactation Undefined
Cost
Chlordiazepoxide (LIBRIUM)
What pharmacies pay · NADAC 9/30/26
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 5 mg | cap | 90 TID | $16.81 | not offered |
| 10 mg | cap | 90 TID | $12.91 | not offered |
| 25 mg | cap | 90 TID | $14.24 | not offered |
Generic entry1982
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySedation, falls, dependence and additive respiratory depression with opioids or other CNS depressants.
Active metabolites
Open Chlordiazepoxide in the interactive console ↗
Memory aids: interaction avatars
