Librium

• Remember to keep any regular appointments with your doctor or clinic. This is so your doctor can check on your progress.
• Chlordiazepoxide is likely to affect your reactions and ability to drive. It is an offence to drive while your reactions are impaired. Do not drive until you know how you react, especially when you first start treatment. Please also be aware that the effects of chlordiazepoxide can last into the following day. Even if your driving ability is not impaired, should you drive, you are advised to carry with you some evidence that the medicine has been prescribed for you - a repeat prescription form or a patient information leaflet from the pack is generally considered suitable.
• Chlordiazepoxide is taken for short periods of time only, often for just a few days. This is because taking it for longer can lead to you feeling dependent on it. Also, your body gets used to it quickly, and after this time it is unlikely to have the same effect.
• If you are going through detox, you will have agreed not to drink any alcohol. Even if you are not taking chlordiazepoxide for this reason, you should still not drink alcohol. It will increase the risk of you experiencing unwanted effects.
• Your doctor could recommend that you reduce your dose of chlordiazepoxide gradually when it is time to stop taking it. This is to reduce the risk of you experiencing withdrawal effects. Follow carefully any instructions your doctor gives to you.
• If you are due to have an operation or any dental treatment, please tell the person carrying out the treatment that you are taking chlordiazepoxide. This is because chlordiazepoxide increases the effects of some anaesthetics.
• After detox, it is thought that you are less likely to go back to drinking heavily if you have counselling to help you to stay off alcohol. Your doctor, practice nurse, or local drug and alcohol unit can provide ongoing support when you are trying to stay off alcohol. Self-help groups such as Alcoholics Anonymous have also helped many people.

1. Librium

Tell your doctor about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or dietary drugs you're taking, especially:

• Antihistamines
• Cimetidine (Tagamet)
• Digoxin (Lanoxin)
• Disulfiram (Antabuse)
• Fluoxetine (Prozac)
• Isoniazid (INH, Laniazid, Nydrazid)
• Ketoconazole (Nizoral)
• Levodopa (Larodopa, Sinemet)
• Medications for depression, seizures, Parkinson's disease, pain, asthma, colds, or allergies
• Metoprolol (Lopressor, Toprol XL)
• Muscle relaxants
• Oral contraceptives
• Probenecid (Benemid)
• Propoxyphene (Darvon)
• Propranolol (Inderal)
• Rifampin (Rifadin)
• Sedatives
• Sleeping pills
• Theophylline (Theo-Dur)
• Tranquilizers
• Valproic acid (Depakene)
• Vitamins

Librium and Other Interactions

Librium may cause drowsiness, dizziness, or blurred vision. Don't drive or operate machinery until you know how this medicine affects you.

Cigarette smoking can decrease the effectiveness of Librium. Tell your doctor if you smoke or use tobacco products.

Librium and Alcohol

Consuming alcohol while using this medicine may increase drowsiness, so avoid alcohol while taking Librium.

Librium, the original chlordiazepoxide HCI and prototype for the benzodiazepine compounds, was synthesized and developed at Hoffmann-La Roche Inc. It is a versatile therapeutic agent of proven value for the relief of anxiety. Librium (chlordiazepoxide) is among the safer of the effective psychopharmacologic compounds available, as demonstrated by extensive clinical evidence.

Librium (chlordiazepoxide) is available as capsules containing 5 mg, 10 mg or 25 mg chlordiazepoxide HCI. Each capsule also contains corn starch, lactose and talc. Gelatin capsule shells may contain methyl.and propyl parabens and potassium sorbater with the following dye systems: 5-mg capsules - FD&C Yellow No. 6 plus D&C Yellow No. 10 and either FD&C Blue No. 1 or FD&C Green No. 3. 10-mg capsules - D&C Yellow No. 10 and either FD&C Blue No. 1 plus FD&C Red No. 3 or FD&C Green No. 3 plus FD&C Red No. 40. 25-mg capsules- D&C Yellow No. 10 and either FD&C Green No. 3 or FD&C Blue No. 1.

Chlordiazepoxide hydrochloride is 7-chloro-2- (methylamino) -5-phenyl-3H-1,4-benzodiazepine 4-oxide hydrochloride. A white to practically white crystalline substance, it is soluble in water. It is unstable in solution and the powder must be protected from light. The molecular weight is 336.22. The structural formula of chlordiazepoxide hydrochloride is as follows:

Manifestations of Librium (chlordiazepoxide) overdosage include somnolence, confusion, coma and diminished reflexes. Respiration, pulse and blood pressure should be monitored, as in all cases of drug overdosage, although, in general, these effects have been minimal following Librium (chlordiazepoxide) overdosage. General supportive measures should be employed, along with immediate gastric lavage. Intravenous fluids should be administered and an adequate airway maintained. Hypotension may be combated by the use of Levophed* (norepinephrine) or Aramine (metaraminol). Dialysis is of limited value. There have been occasional reports of excitation in patients following chlordiazepoxide HCI overdosage; if this occurs barbiturates should not be used. As with the management of intentional overdosage with any drug, it should be borne in mind that multiple agents may have been ingested.

Flumazenil, a specific benzodiazepine-receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for resedation, respiratory depression and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert, including CONTRAINDICATIONS, WARNINGS and PRECAUTIONS, should be consulted prior to use.

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of chlordiazepoxide in the elderly. However, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness are more likely to occur in the elderly, who are usually more sensitive than younger adults to the effects of chlordiazepoxide. Elderly patients may require a lower dose to help reduce unwanted effects.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Librium, there are no specific foods that you must exclude from your diet when receiving this medication.

Take Librium exactly as prescribed.

This medication comes in capsule form and is taken up to 4 times a day, with or without food.

Alcohol may intensify some of the side effects of this medication.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Librium at the same time.

• Effects appear to be mediated through the inhibitory neurotransmitter GABA; the site and mechanism of action within the CNS appear to involve a macromolecular complex (GABAA-receptor-chloride ionophore complex) that includes GABAA receptors, high-affinity benzodiazepine receptors, and chloride channels.

Librium is indicated for the management of anxiety disorders or for the short term relief of symptoms of anxiety, withdrawal symptoms of acute alcoholism, and preoperative apprehension and anxiety.  Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.

The effectiveness of Librium in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies.  The physician should periodically reassess the usefulness of the drug for the individual patient.

Because of the wide range of clinical indications for Librium, the optimum dosage varies with the diagnosis and response of the individual patient.  The dosage, therefore, should be individualized for maximum beneficial effects.

Preoperative Apprehension and Anxiety:  On days preceding surgery, 5 to 10 mg orally, 3 or 4 times daily.  If used as preoperative medication, 50 to 100 mg IM* 1 hour prior to surgery.

For the relief of withdrawal symptoms of acute alcoholism, the parenteral form* is usually used initially.  If the drug is administered orally, the suggested initial dose is 50 to 100 mg, to be followed by repeated doses as needed until agitation is controlled – up to 300 mg per day.  Dosage should then be reduced to maintenance levels.

*See package insert for Injectable Librium (chlordiazepoxide HCl).