Long-acting benzodiazepine Pregnancy: Should not be used during pregnancy, especially the first and last trimester, unless the clinical condition of the woman requires it; chlordiazepoxide crosses the placenta and animal studies have shown reproductive toxicity. High doses or prolonged low doses in the last trimester or during labour may produce foetal heart-rate irregularities, moderate respiratory depression, hypotonia, poor sucking and neonatal hypothermia, with a risk of neonatal withdrawal after chronic maternal use. Avoid during breast-feeding if possible. Because of genotoxic potential, women of childbearing potential should use effective contraception during treatment and for 7 months afterwards, and men should use effective contraception and not father a child during treatment and for 4 months afterwards (SPC 4.6).

Chlordiazepoxide hydrochloride

Brand names: Librium

Chlordiazepoxide is a long-acting benzodiazepine used mainly for the management of acute alcohol withdrawal and, short term, for severe anxiety.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg (anxiety states, usual dose); 20 mg for severe symptoms

Route: Oral

Frequency: 10 mg 2-3 times a day (up to 30 mg daily in divided doses); for severe symptoms 20 mg 2-4 times a day

Max: Up to 100 mg daily in divided doses

Source product is Librium 10 mg Capsules (chlordiazepoxide hydrochloride) - the same SPC as the chlordiazepoxide entry. Dose adjusted on an individual basis. Anxiety states: duration of treatment should generally not be more than 4 weeks, including a tapering-off process. Insomnia associated with anxiety: 10-30 mg before retiring; duration generally a few days to two weeks, maximum four weeks including tapering. Symptomatic relief of acute alcohol withdrawal: 25-100 mg, repeated if necessary in 2 to 4 hours. Muscle spasm of varied aetiology: 10-30 mg daily in divided doses. Elderly or debilitated patients, patients with organic brain damage, respiratory impairment and/or hepatic or renal dysfunction should normally not exceed half of the doses normally recommended; use the lowest dose that controls symptoms. Chlordiazepoxide is a long-acting benzodiazepine - monitor regularly at the start of treatment and reduce dose or frequency if needed to prevent overdose due to accumulation. Treatment should not be continued at the full dose beyond four weeks and should always be tapered off gradually; long-term chronic use is not recommended. If used for epilepsy, use for as long as the prescriber considers necessary. Paediatric: Librium is not for paediatric use. Capsules must be taken with water and not chewed. eMC section 4.5 was not captured in this bundle (section 4.4 truncated at the source-fetch limit), so no interaction list is given.

Dose adjustments

Renal

Patients with hepatic or renal dysfunction (and elderly or debilitated patients, organic brain damage, respiratory impairment) should normally not exceed half of the doses normally recommended (SPC 4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to chlordiazepoxide or any of the excipients
Myasthenia gravis
Severe pulmonary insufficiency
Respiratory depression
Severe hepatic insufficiency
Sleep apnoea syndrome
Phobic or obsessional states
Chronic psychosis
Spinal or cerebral ataxia

Side effects

Drowsiness, sedation, somnolence and fatigue - dose-related and may persist into the following day even after a single dose (common)
Dizziness, unsteadiness, ataxia, balance disorder and confusional states (common); elderly are particularly sensitive and may become confused
Falls and consequent fractures in the elderly due to the myorelaxant effect; muscle weakness
Respiratory depression (frequency not known); hypotension (rare)
Urinary retention and incontinence (rare); visual impairment including diplopia (rare)
Drug dependence, paradoxical drug reactions (anxiety, insomnia, agitation, aggression, suicidal ideation) and drug withdrawal symptoms
Rare bone marrow depression (thrombocytopenia, leukopenia, agranulocytosis, pancytopenia); jaundice and raised transaminases (frequency not known)

Clinical monograph

How it works

It enhances the inhibitory action of GABA at the GABA-A receptor, increasing chloride conductance to produce anxiolytic, sedative and anticonvulsant effects.

Prescribing in practice

It carries a risk of dependence and should be used in a short, reducing course; in alcohol withdrawal it is given as a tapering regimen rather than open-ended.
Combining it with alcohol or other CNS depressants, particularly opioids, increases the risk of profound sedation and respiratory depression.
Use reduced dosing and added caution in the elderly and in hepatic impairment, where accumulation increases the risk of falls and confusion.

Monitoring

Monitor withdrawal severity (for example using a recognised withdrawal scale), level of sedation and respiratory status during treatment.

Counselling the patient

Do not drink alcohol while taking this medicine.
It can make you drowsy and impair driving and operating machinery.
Take it only for the planned short course, as longer use can lead to dependence.

Evidence & guidelines

Benzodiazepines such as chlordiazepoxide are the recommended treatment for preventing and managing alcohol-withdrawal symptoms in NICE guidance.

Reference: NICE CG100; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways