chlordiazepoxide

Adjunctive therapy

Brands: LIBRIUM

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is chlordiazepoxide?
Chlordiazepoxide (brand Librium) 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).
What is LIBRIUM?
LIBRIUM is a brand name for chlordiazepoxide.
What is LIBRIUM (chlordiazepoxide) used for?
Label indications include: Anxiety disorders / short-term relief of anxiety symptoms; withdrawal symptoms of acute alcoholism; and preoperative apprehension/anxiety (label).
What drug class is LIBRIUM (chlordiazepoxide)?
Benzodiazepine; positive allosteric modulator of GABA-A receptors.
What strengths does LIBRIUM (chlordiazepoxide) come in?
Capsules: 5 mg, 10 mg, 25 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: LIBRIUM
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Anxiety disorders / short-term relief of anxiety symptoms; withdrawal symptoms of acute alcoholism; and preoperative apprehension/anxiety (label).

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Clinical Highlights

Chlordiazepoxide (brand Librium) 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 (24–48 hours on label) can smooth withdrawal symptoms but increases accumulation and next-day impairment risk; it is not a good fit for chronic “as needed” anxiety prescribing.

Alcohol withdrawal treatment should follow a structured protocol with frequent monitoring; converting withdrawal regimens into indefinite outpatient benzodiazepine therapy is generally avoided once the acute phase resolves.
Boxed warning: benzodiazepines plus opioids can cause fatal respiratory depression. Co-prescribing with opioids is generally avoided, and combining with alcohol or other sedatives increases risk.
The compare view, the chlordiazepoxide evidence feed, and the chlordiazepoxide print page can support safe-use counseling and shared decision-making.
In older or medically fragile patients, oversedation and falls are common failure modes; conservative dosing and frequent reassessment are typical (label).
For chronic anxiety, psychotherapy and SSRI/SNRI-based strategies are typically preferred over long-term benzodiazepine maintenance (guidelines).

Dosing & Formulations

Capsules: 5 mg, 10 mg, 25 mg (label). Label dosing is divided and varies by indication and severity; use the lowest effective dose for the shortest feasible duration, with frequent reassessment (label).

For alcohol withdrawal, follow a protocolized symptom-triggered or fixed-dose taper strategy and adjust based on vitals/withdrawal scoring rather than subjective anxiety alone (guidelines).
In elderly or debilitated patients, limit doses initially (often 10 mg per day or less) and titrate cautiously to reduce ataxia and oversedation (label).

Monitoring & Risks

Boxed warning: Concomitant use with opioids can cause profound sedation, respiratory depression, coma, and death (label). Accumulation risk: long half-life increases next-day impairment, delirium, and fall risk—especially in older adults.

Dependence and withdrawal: monitor for tolerance and withdrawal symptoms; abrupt discontinuation after prolonged use is avoided.
Respiratory disease and sedative co-prescriptions amplify risk; screen for sleep apnea/COPD and alcohol use before renewing.

Drug Interactions

Additive CNS and respiratory depression with opioids, alcohol, antihistamines, and other sedatives; stacking sedatives is generally avoided. Long half-life means interactions can have prolonged clinical impact; changes in co-prescribed sedatives should prompt reassessment for oversedation and falls.

If concomitant sedatives are unavoidable, keep doses conservative and increase follow-up frequency.

Practice Notes

Alcohol withdrawal is typically managed with a protocolized approach and an explicit taper/stop date; converting withdrawal prescriptions into chronic anxiety management is generally avoided. For chronic anxiety, psychotherapy and SSRI/SNRI plans are typically prioritized, with benzodiazepines reserved for time-limited, goal-directed use.

If discontinuing after extended use, gradual tapering and monitoring for rebound anxiety/insomnia and functional relapse are typical.
In older adults, safer alternatives are often preferred and necessity is reassessed frequently; long half-life increases fall and delirium risk.

References

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