Chlordiazepoxide
Librium · Librax
BenzodiazepineSchedule IVGeneric availableTDM data
Clinical Pharmacology Chlordiazepoxide HCl has antianxiety, sedative, appetite-stimulating and weak analgesic actions. The precise mechanism of action is not known. The drug blocks EEG arousal from stimulation of the brain stem reticular formation. Animal studies suggest action on the limbic system of the brain, which is involved in emotional responses.
Compare Chlordiazepoxide →FDA-Approved Indications
- Emotional and somatic factors in gastrointestinal disorders
- Adjunctive therapy in peptic ulcer
- Irritable bowel syndrome
Common Off-Label Uses
- Irritable bowel syndrome (in combination products)
What Sets This Drug Apart
- Very long-acting (t1/2 5-30h parent, active metabolites up to 200h); historically the first benzodiazepine introduced clinically (Librium, 1960)
- Primary clinical niche: structured alcohol withdrawal protocols (symptom-triggered or fixed-schedule dosing) — long half-life provides smooth coverage
- Active metabolites (demoxepam, desmethyldiazepam) accumulate unpredictably, especially in elderly and hepatic impairment
- Not appropriate for severe alcohol withdrawal (high CIWA scores); shorter-acting benzos with predictable kinetics preferred in ICU settings
- Available as Librax (with clidinium) for GI/anxiety combination — unique fixed-dose combination among benzos
Boxed Warning
WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS