II. Class

  1. Long Acting Benzodiazepine

III. Dosing

  1. Anxiety Disorder
    1. Adult: 5 to 10 mg orally 2 to 4 times daily (up to 20 to 25 mg per dose)
    2. Elderly: 5 mg orally 2 to 4 times daily
    3. Child (over age 6 years): 5 mg orally 2 to 4 times daily (up to 10 mg orally 2 to 3 times daily)
  2. Alcohol Withdrawal
    1. See Alcohol Withdrawal
    2. Start 25 to 50 mg orally every 3 to 4 hours as needed
    3. May increase doses to 50-100 mg
    4. Repeat dosing every 3-4 hours up to 300 mg per day

IV. Safety

  1. Pregnancy Category X
  2. Avoid in Lactation
  3. Schedule IV Controlled Substance

V. Pharmacokinetics

  1. Onset: 6 hours
  2. Half Life: 7-48 hours (up to 100 hours)
  3. Chlordiazepoxide has the longest half life of any Benzodiazepine

VI. Metabolism

  1. Chlordiazepoxide is metabolized first to desmethyldiazepam via CYP1A2
  2. Desmethyldiazepam is then metabolized to Oxazepam via CYP3A4 and CYP2C19

VIII. References

  1. (2019) Med Lett Drugs Ther 61(1578): 121-6
  2. (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

chlordiazepoxide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CHLORDIAZEPOXIDE 10 MG CAPSULE Generic $0.13 each
CHLORDIAZEPOXIDE 25 MG CAPSULE Generic $0.16 each
CHLORDIAZEPOXIDE 5 MG CAPSULE Generic $0.19 each
CHLORDIAZEPOXIDE-CLIDINIUM CAP Generic $0.44 each

Ontology: Chlordiazepoxide (C0008188)

Definition (NCI) A long-acting benzodiazepine with anxiolytic, sedative and hypnotic activity. Chlordiazepoxide exerts its effect by binding to the benzodiazepine site at the gamma-aminobutyric acid (GABA) receptor-chloride ionophore complex in the central nervous system (CNS). This leads to an increase in the opening of chloride channels, membrane hyperpolarization and increases the inhibitory effect of GABA on the CNS.
Definition (MSH) An anxiolytic benzodiazepine derivative with anticonvulsant, sedative, and amnesic properties. It has also been used in the symptomatic treatment of alcohol withdrawal.
Definition (CSP) anxiolytic benzodiazepine derivative with anticonvulsant, sedative, and amnesic properties; also used in the symptomatic treatment of alcohol withdrawal.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002707
SnomedCT 372866006, 82746003
LNC LP16068-6, MTHU006722
English Methaminodiazepoxide, 7 Chloro N methyl 5 phenyl 3H 1,4 benzodiazepin 2 amine 4 oxide, 7-Chloro-N-methyl-5-phenyl-3H-1,4-benzodiazepin-2-amine 4-oxide, 3H-1,4-Benzodiazepin-2-amine, 7-chloro-N-methyl-5-phenyl-, 4-oxide, 3H-1,4-Benzodiazepin-2-amine, 7-chloro-N-methyl-5-phenyl, 4-oxide, chlordiazepoxide, chlordiazepoxide (discontinued), chlordiazepoxide (discontinued) (medication), Chlordiazepoxide, CHLORDIAZEPOXIDE, Chlordiazepoxide [Chemical/Ingredient], methaminodiazepoxide, chlordiazePOXIDE, Chlordiazepoxide (product), Chlordiazepoxide (substance)
Swedish Klordiazepoxid
Czech chlordiazepoxid
Finnish Klooridiatsepoksidi
Russian KHLOZEPID, LIBRIUM, NAPOTON, KHLORDIAZEPOKSID, METAMINODIAZEPOKSID, ELENIUM, ЛИБРИУМ, МЕТАМИНОДИАЗЕПОКСИД, НАПОТОН, ХЛОЗЕПИД, ХЛОРДИАЗЕПОКСИД, ЭЛЕНИУМ
Japanese クロルジアゼポキシド, メタミノジアゼポキシド
Italian Metaminodiazepossido, Clordiazepossido
Croatian KLORDIAZEPOKSID
Spanish clordiacepóxido (producto), clordiacepóxido, clordiazepóxido, clordiazepóxido (sustancia), clordiazepóxido (producto), Metaminodiazepóxido, Clorodiacepóxido, Clordiacepóxido, Librium, Clorodiazepóxido, Metaminodiacepóxido, clordiacepóxido (sustancia), Clordiazepóxido
Polish Chlordiazepoksyd, Elenium, Librium
Portuguese Librium, Clordiazepóxido, Metaminodiazepóxido
French Chlordiazépoxyde
German Chlordiazepoxid, Methaminodiazepoxid

Ontology: Librium (C0013881)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002707
English librium, Librium