Chlordiazepoxide (Librium): Uses, Side Effects, Dosage, & More

What Is Chlordiazepoxide Used to Treat?

Chlordiazepoxide can be used to treat anxiety, though it is not a first-line therapy. If a benzodiazepine is determined to be needed in someone’s therapy, then typically a medication like Klonopin would be chosen first because of how quickly it acts and how easily the body can process it afterward. This medication is approved for those above 6 years old.

There are also non-FDA-approved uses for this medication. A prescriber may choose to use a medication off-label when the FDA hasn’t approved it for that use because it has shown benefit for certain non-FDA-approved conditions.

Chlordiazepoxide is commonly used as an FDA-approved medication to treat:^1,2

• Short term relief for symptoms of anxiety
• Withdrawal symptoms of acute alcoholism
• Preoperative apprehension and anxiety

Chlordiazepoxide can also be used off-label (non-FDA-approved) for treating:³

• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Anxiety associated with other medical conditions
• Catatonia (lack of movement, confusion, unusual behavior)

Who Should Not Take Chlordiazepoxide?

People who may need to avoid chlordiazepoxide are those who have substance use disorders, patients on opioids, the elderly, and people with liver problems. Chlordiazepoxide is a drug that can be habit-forming, so those who have active addictions or a history of addiction to the benzodiazepine class of medication should weigh the benefits and risks of starting this medication with their doctor.

Those taking opioids may also need to avoid this medication because the two medications can interact to increase the risk of serious side effects like slower breathing and sleepiness. Patients with liver problems should be aware that this medication can stick around longer in the body due to their liver not working well and this may result in side effects.

For this reason, there should be caution in using this medication in the elderly as they typically have slower clearance of medications, possibly increasing their risk of serious side effects as well as falls. Pregnant patients may be advised not to take this medication as it can cause sedation and withdrawal syndrome in their babies.

People who may need to avoid taking chlordiazepoxide include:^1,2,3,4

• Patients with active substance use disorders
• Patients with a history of misusing benzodiazepines
• Patients on opioids
• Those with liver problems
• Elderly patients
• Pregnant patients

Chlordiazepoxide Dosages for FDA-Approved Treatment

Dosages can vary from person to person depending on the reason that they are taking chlordiazepoxide, and the person’s age, and other health factors. The right dosage can be different from person to person. The following dosages are FDA-approved, meaning that the FDA has deemed that this medication is safe and effective for its intended use.

Typically, adults are prescribed 5 to 10 mg given 3 or 4 times daily for mild to moderate anxiety disorders while severe anxiety disorders are usually started at 20 to 25 mg given 3 or 4 times daily. Geriatric patients and those with debilitating diseases usually start at 5 mg, 2 to 4 times daily. Pediatric patients are usually prescribed 5 mg, 2 to 4 times daily which may be increased in some pediatric patients to 10 mg, 2 to 3 times daily.^1,3

Chlordiazepoxide Forms & Strengths

Chlordiazepoxide is supplied as an immediate-release capsule in 5 mg, 10 mg, and 25 mg strengths.¹ The right strength is determined by your doctor who considers your age, what you are trying to treat, and other factors. Chlordiazepoxide typically takes 30 minutes to an hour to take effect.

Chlordiazepoxide is available in the following forms and strengths:^1,2

• 5 mg oral capsule
• 10 mg oral capsule
• 25 mg oral capsule

It is important for patients to take medications as prescribed by their doctor. Taking this medication in ways that are not approved can lead to serious side effects. Swallow these capsules whole with or without food.

How Should I Take Chlordiazepoxide?

It is important to take chlordiazepoxide as prescribed and to take it exactly as you are instructed to by your doctor. If you are taking it as needed, then only take it in those instances. Chlordiazepoxide can be taken with or without food and should be swallowed whole.²

Patients should be aware that it is advised not to take chlordiazepoxide if they are consuming alcohol. To minimize the risk of side effects, do not take the medication while consuming alcohol. If you don’t want to give up alcohol, talk to your doctor about other alternative treatments besides chlordiazepoxide.^1,2,3,4

What Happens If I Miss a Dose of Chlordiazepoxide?

Take chlordiazepoxide as soon as you can, but skip your missed dose if it is almost time for your next scheduled dose.² Do not double up on doses to make up for any doses you may have missed as it may lead to serious side effects. Do not stop taking chlordiazepoxide abruptly since this can cause withdrawal symptoms, leading to potentially serious side effects like seizures. Always discuss with a doctor if you have thoughts of stopping this medication.

Side Effects of Chlordiazepoxide

Chlordiazepoxide’s effect on the nervous system means that the side effects often seen have to do with drowsiness, loss of control of body movements, and mental status changes. The medication works to decrease the amount of nerve activity in the brain to help calm you when you are anxious.

Patients should be aware of any serious side effects and seek immediate medical attention should they appear. There is also the side effect of abuse and dependence that can develop in patients, often leading these individuals to seek more of the medication.

Common Side Effects of Chlordiazepoxide

As with all medications, there are side effects that people can potentially experience. Chlordiazepoxide works on the central nervous system which affects your motor skills as well as makes you sleepy. Generally, you do not need to seek medical care for common side effects, but if it is impacting daily life or you see a change in mental state, then you should seek immediate medical care.^1,2,3

Common side effects of chlordiazepoxide include:*

• Drowsiness
• Sedation
• Confusion
• Dizziness
• Light Headedness
• Unsteadiness
• Difficulty with fine motor tasks (eating, writing, etc.)

*All medications, including chlordiazepoxide, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Serious Side Effects of Chlordiazepoxide

Serious side effects are when the side effects impact your ability to function normally. These are generally seen with extreme confusion, inability to breathe, or the inability to stay awake. These symptoms are rare, but the risk of them occurring increases with abuse of the medication or in combination with sedating medications. If you have these or other serious symptoms, seek immediate medical care.^1,2,3

Serious side effects of chlordiazepoxide may include:*

• Unable to stay awake
• Shallow or slow breathing
• Confusion, paranoia, anger, aggression, excitement
• Problems with memory or concentrating
• Withdrawal

*All medications, including chlordiazepoxide, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Chlordiazepoxide Withdrawal

Continual usage of chlordiazepoxide may lead to physical or psychological dependence and an abrupt discontinuation or reduction in dosage may result in a withdrawal reaction. This can be life-threatening, so immediate medical care is required if a withdrawal is occurring.

These withdrawal symptoms can last weeks to more than 12 months and can include symptoms such as psychosis, seizures, tremors, change in mental state (ie confusion or inability to recognize your surroundings), and rapid pulse.¹

Allergic Reactions to Chlordiazepoxide

While rare there is a potential for someone to be allergic to chlordiazepoxide. You might be allergic to it if you have had a previous allergic reaction to the ingredients used to make the capsule or the medication itself. Those who are hypersensitive or have had allergic reactions to other drugs in the benzodiazepine class of medications may potentially be unable to tolerate this medication as well.¹

Allergic reactions to chlordiazepoxide may include:⁵

• Rash or hives
• Itching or swelling, especially of the face/tongue/throat/ears
• Severe dizziness
• Trouble breathing
• Weak or rapid pulse
• Nausea
• Vomiting
• Diarrhea

If you experience these allergic reactions, seek immediate medical attention and call 911 to prevent any serious reactions from occurring. After the event, do not take the medication again, and contact your pharmacist and doctor to update them on what happened. Your doctor will then find another therapy to manage your condition.

Chlordiazepoxide Warnings & Precautions

There are some precautions that should be considered before someone decides to take chlordiazepoxide. These considerations may range from current medications that they take, such as opioids or other psychiatric medications, to having specific health conditions that may increase their risk of adverse events, like being pregnant or having psychiatric conditions. If these precautions apply to you, then you should discuss with your doctor if the benefits of taking chlordiazepoxide outweigh the risks.

Precautions for taking chlordiazepoxide include:^1,2

• Patients on psychiatric or opioid medications: Taking chlordiazepoxide and other psychiatric agents or opioids at the same time is not recommended. Taking them together may result in increased suppression of the nervous system, leading to serious side effects like profound sedation, decreased breathing, coma, and death.
• Elderly and debilitated patients: It is recommended that the dosage be limited to the smallest effective amount for these patients. This is to prevent the development of motor issues and oversedation.
• Patients with kidney or liver issues: Kidney and liver impairment should be taken into consideration since poor functioning can cause the drug to last longer in patients, potentially increasing side effects.
• Psychiatric and hyperactive aggressive pediatric patients: These populations should be watched on this therapy because they can get a paradoxical reaction, experiencing symptoms like excitement and sudden or severe rage.
• Pediatric patients have a varied response to medications like chlordiazepoxide, so they should be started on the lowest dose. There is little data on children under 6 years of age, so it is not recommended to start chlordiazepoxide in this group.
• Potential for misuse and addiction: Patients should be aware that chlordiazepoxide has a risk of abuse, misuse, and addiction. This can lead to overdose and death, especially in combination with other substances.
• Dependence and withdrawal reactions may result when patients suddenly discontinue or rapidly reduce the dosage from those who take higher dosages or have had longer durations of use.
• Pregnancy and breastfeeding: Pregnant patients should be aware that usage of chlordiazepoxide late in pregnancy may result in sedation of the newborn and/or withdrawal symptoms. Breastfeeding is also not recommended during treatment with chlordiazepoxide.

Interactions With Chlordiazepoxide

Chlordiazepoxide is a medication that works on the central nervous system, so other medications that work on the same system can create stronger side effects. This can lead to complications like reduced breathing, slow heart rate, coma, and even death. There are some medications and substances that should be avoided being taken together with chlordiazepoxide.  In exceptional circumstances with the guidance of your doctor, it can be safe to take together so long as you follow directions.

4 substances you should avoid while taking chlordiazepoxide include:^1,3

• Opioids, because doing so increases the risk of opioid-related breathing issues.
• Alcohol, because it suppresses the central nervous system along with chlordiazepoxide, increasing the risk of sedation and suppression of breathing.
• Muscle relaxers, because while they can help with muscle pain or discomfort, taking them chlordiazepoxide can make you sleepy or slow your breathing.
• Benadryl, also called diphenhydramine, because it has the side effect of depressing your nervous system, leading to the same dangerous side effects as mentioned above.

Can You Overdose on Chlordiazepoxide?

There is a potential for overdose on chlordiazepoxide. This can occur when a person is taking more than the recommended dose of medication or when it is combined with other substances, like alcohol or opioids. If you or another person are experiencing these signs or symptoms, then immediately call 911. Seeking immediate medical attention in a timely manner is important for reducing the likelihood of serious outcomes like death. ^1,2,3,4

Some signs and symptoms of a chlordiazepoxide overdose include:

• Trouble breathing
• Confusion and disorientation
• Weakness
• Tremors
• Uncoordinated muscle movements
• Bluish fingernails and lips
• Blurred or double vision
• Extreme dizziness
• Coma

What Should You Do If You Take Too Much Chlordiazepoxide?

If you have taken too much chlordiazepoxide, immediately contact the appropriate medical services. Calling poison control (1-800-222-1222) can help determine if you need to take further action to prevent a serious event. If you or another person are experiencing signs of overdose, call 911. Do not attempt to take matters into your own hands and seek professional help.

Questions to Ask Your Healthcare Provider About Chlordiazepoxide

It is wise to discuss any potential medication changes with your doctor before and during the treatment process. Make sure your entire treatment team knows about any medication changes that may occur, including your psychiatrist or therapist. If you are changing doctors and need help with your medications, online psychiatry services may be of benefit. They offer convenient medication management, at times cheaper than traditional office visits.

Questions to ask your care team about chlordiazepoxide include:

• How long will it take for me to adjust to taking chlordiazepoxide?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Is there anything I should tell my therapist about this new medication?
• Are there any medications, foods, or supplements I should avoid while taking chlordiazepoxide?
• How should I take chlordiazepoxide? With or without food? The timing?
• How long should I take chlordiazepoxide?
• Am I at increased risk for addiction?
• How often should I get checkups while taking chlordiazepoxide?
• What side effects should I seek immediate medical attention for?

In My Experience

In my experience, chlordiazepoxide is not the first medication used in the treatment of anxiety. It will typically be used only if other short-term anxiety relief medications do not work for the patient and it is usually intended to be used short-term. Although that may be the case, it is an effective medication and can benefit the patients. You should always discuss with your doctor if you feel that your treatment is not working for you and follow their guidance as treatment may look different from person to person.

For Further Reading

• How Long Does it Take for Anxiety Medication to Work?
• How to Get Anxiety Medication: Everything You Need to Know
• Anxiety Treatment: Therapy, Medication, Lifestyle & Self Help