chlordiazepoxide

General Information

Chlordiazepoxide is a long-acting benzodiazepine indicated for the management of anxiety disorders (or short-term relief of anxiety symptoms), withdrawal symptoms of acute alcoholism, and preoperative apprehension/anxiety (label).

Long half-life can smooth withdrawal symptoms but increases accumulation and next-day impairment risk; it is not a good fit for chronic “PRN” anxiety prescribing.

Because of its long duration, chlordiazepoxide is sometimes used in structured withdrawal protocols or taper plans, but this should be paired with clear monitoring and stop dates; large outpatient quantities that drift into chronic use are generally avoided.

For alcohol withdrawal, use protocolized monitoring and taper as symptoms resolve; converting withdrawal regimens into chronic outpatient benzodiazepine therapy is generally avoided once the acute phase ends.

Co-prescribing with opioids and alcohol is generally avoided (boxed warning for opioid combinations), and fall and driving safety is reassessed at every renewal.

The chlordiazepoxide compare view, the chlordiazepoxide evidence feed, and the chlordiazepoxide print page can support safe-use counseling and shared decision-making.

Chlordiazepoxide is commonly used in alcohol withdrawal protocols due to its long half-life, but that same long half-life increases accumulation, falls, and delirium risk in older adults and with polypharmacy. Use protocolized monitoring, document taper/stop dates, and avoid chronic anxiety maintenance use.

Mechanism of Action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Positive allosteric modulator of GABA-A receptors, producing anxiolytic, sedative, and anticonvulsant effects through increased inhibitory neurotransmission.

Long half-life can smooth symptom fluctuations but also increases carry-over sedation and cognitive slowing.

Tolerance and dependence can develop with repeated use; abrupt discontinuation after prolonged courses can produce withdrawal.

• GABA-A receptor positive allosteric modulation.

Metabolism and Pharmacokinetics

• Half-life is reported between 24 and 48 hours with slow decline after discontinuation (label).
• Peak blood levels occur several hours after dosing; adding extra doses when symptoms fluctuate can increase accumulation (label).
• Excreted in urine with ~1–2% unchanged and ~3–6% as conjugate (label).
• Long washout means impairment can persist for days after dose changes or discontinuation; plan medication adjustments and safety counseling accordingly.

Dosing and Administration

• Dosing varies by indication and severity; use the lowest effective dose for the shortest feasible duration, with frequent reassessment (label).
• Alcohol withdrawal should follow a structured taper strategy with frequent monitoring rather than indefinite continuation (guidelines).
• Elderly and debilitated patients require conservative dosing to reduce ataxia and oversedation (label).
• If used beyond a short course, taper gradually to discontinue.

Monitoring & Labs

• Alcohol withdrawal: use a structured protocol (vitals, withdrawal scoring) and taper as symptoms resolve.
• Screening for opioid co-prescribing, alcohol use, sleep apnea/COPD, and fall risk is important before prescribing.
• Monitoring focuses on oversedation, ataxia, confusion, and next-day impairment—especially in older adults.
• If use extends beyond a short course, documenting a gradual taper plan and monitoring for withdrawal is typical.

Sources: FDA/DailyMed label; ASAM alcohol withdrawal guideline; benzodiazepine safety guidance.

Adverse Effects

Interactions

• Additive CNS/respiratory depression with opioids, alcohol, antihistamines, and other sedatives.
• Long half-life means interactions can produce prolonged oversedation; reassessment is important after any sedative regimen change.
• Combining multiple hypnotics is generally avoided except in exceptional, closely monitored circumstances.

Other Useful Information

• Protocolized alcohol withdrawal management and a taper/stop date help prevent chronic benzodiazepine continuation.
• For chronic anxiety, psychotherapy and SSRI/SNRI strategies are typically preferred over long-term benzodiazepine maintenance.
• Driving or operating machinery is often avoided until medication effects are known; carry-over sedation can persist into the next day.
• When discontinuing after longer use, gradual tapering and monitoring for rebound anxiety, insomnia, tremor, and functional relapse are typical.

References

1. Chlordiazepoxide hydrochloride prescribing information — DailyMed (2025)
2. ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
3. The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management — Journal of Addiction Medicine (2020)