Author: James Anderson
Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials PMC
Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as diazepam, lorazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. The benzodiazepine class consists of many well-known and widely used medications. These widely used prescription drugs include Chlordiazepoxide prescribed under the brand name Librium.
In a worst-case scenario, an overdose can lead to coma or death. Additional limitations were the clinical heterogeneity of the included studies the fact that we had to convert the different benzodiazepines used to lorazepam equivalents. Because of the limited number of studies, we did not explore heterogeneity using subgroup analysis or meta-regression.
Addicts can also experience sleeplessness and irritability when their drug is suddenly restricted. Chlordiazepoxide is available as a capsule with 3 different strengths—5 mg, 10 mg, and 25 mg—for oral dosing and as an injectable with a concentration of 100 mg/5 mL. Typically available in gelatin capsule form, it is advised to store chlordiazepoxide between 68 °F and 77°F (20 °C to 25 °C). The recommended approach is to administer the lowest effective dose, especially for pediatric patients aged 6 and older and geriatric patients. Injectable forms are not recommended for pediatric patients, and no data exist on their long-term effects. Chlordiazepoxide has anti-anxiety, sedative, appetite-stimulating, and myorelaxant actions.
- This in-depth knowledge facilitates informed decision-making in prescribing chlordiazepoxide, optimizing dosage regimens, and minimizing the risk of potential adverse reactions.
- Librium is a brand name for the chemical compound called chlordiazepoxide.
- Guidelines recommend dosing based on objectively measured symptoms (symptom-triggered therapy) rather than fixed dose regimens.
- Given the high prevalence of alcohol use disorder and alcohol withdrawal syndrome in hospital settings, there is an urgent need for further studies to assess the optimal method of management of these conditions in the hospital.
- Interventions include securing the airway and providing adequate intravenous fluid resuscitation.
Nurses can counsel the patient, answer questions, monitor for signs of adverse effects, and verify patient compliance. The pharmacist should verify that the dosing is appropriate for the condition, check the medication profile for drug interactions, and be available to counsel the patient. Both pharmacy and nursing must have a clear communication channel to the prescriber. An addiction medicine specialist should be consulted in chlordiazepoxide for acute alcohol withdrawal.
Early Alcohol Withdrawal Symptoms
Immediate care involves detoxification and easing the initial stages of withdrawal in which symptoms may be most severe. Rehabilitation follows the detoxification steps and it must address any related or hidden medical or psychological problems. After detoxification and rehabilitation, patients enter the recovery phase. In recovery, patients must learn to live drug-free, and for many recovering persons, the recovery phase can be a life-long effort.
When the drugs are mixed, patients risk overdose and an addiction that is complicated by the presence of two drugs. Drug interactions may change how your medications work or increase your risk for serious side effects. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval. Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol).
Most studies had some type of bias that was rated as unclear or high risk of bias, including bias related to randomization and blinding. Reporting bias was generally rated as low except for the study by Weaver which for the outcome of total benzodiazepine appeared to report only on the subset of patients that had data on CIWA-Ar scores. Several studies were also rated as high risk of bias for the outcomes of duration of treatment and total benzodiazepine given because of a design bias [19–21].
Interactions of Alcohol and Chlordiazepoxide
Chlordiazepoxide is known to have many side effects that impact physical mobility, cognition, and other biological changes. Users may find that they feel off-balance when using the drug and may even have difficulty keeping their movements under control. Patients who experience difficulty should consult with their doctor to determine whether or not it’s a good idea to drive while using this drug.
Without Librium, that therapy and preparation might never happen. Librium’s effectiveness in the use of alcohol withdrawal has resulted in several organizations deploying it. Officials at the Hancock County Jail in Maine administer Librium to inmates who are going through withdrawal. The decision to provide the drug, and the administration thereof, is done in consultation with the onsite nurse practitioner.
Read the Medication Guide provided by your pharmacist before you start taking chlordiazepoxide and each time you get a refill. Librium and alcohol each change blood chemistry and affect nerves in the central nervous system and the brain. Heavy used of these substances creates long-term changes in the brain and nerve activity. The body adjusts to the constant supply of alcohol or Librium and the subsequent reduction of nerve activity. Addiction involves a loss of control over your use of one or more drugs or substances. Addictions arise from the use of alcohol and other drugs that change the brain and body chemistry.
Alcohol Poisoning and Chlordiazepoxide Overdose
Once users experience the heightened effects, they are more likely to mix the two again. They may even graduate to stronger drugs that deliver a similar, stronger impact to the nervous system. Delirium tremens (DT), a potentially deadly cluster of symptoms involving agitation, disorientation, fever, sweating, and high blood pressure, is sometimes experienced as part of withdrawal in heavy alcohol drinkers. Benzodiazepines are typically given to patients at high risk of DT as it usually is protective against it. Taken as prescribed, Librium offers a lower risk than many other similar drugs.
Doctors often prescribe drugs to help with the effects of alcohol withdrawal, including Librium. Librium acts to quiet the nerves in the central nervous system and the brain. The depressed nerves have lower levels of activity which reduces anxiety, panic, and other withdrawal symptoms. Although any depressant mixed with alcohol is dangerous, benzodiazepines are the most commonly linked to overdose deaths in the United States. When Librium and alcohol are taken together, users report drowsiness, dizziness and find it extremely difficult to concentrate.
In more severe cases of alcohol dependence, patients might experience seizures and hallucinations as they withdraw from drinking. Around 5 percent of people who experience delirium tremens do not survive withdrawal. For dichotomous outcomes such as delirium, we calculated odds ratios when sufficient data was available. For continuous variables, we used means and standard deviations to calculate mean differences in outcomes between symptom-triggered groups and fixed dose groups. Statistical analysis was performed using Stata/SE, version 14.2 (StataCorp, College Station, TX).
However, even when taken as prescribed, Librium can cause dependency. Doctors and patients must work together to reduce the risk of addiction. Patients benefit from prompt and honest reporting of signs of dependency including drug interaction with alcohol, opioids, and street drugs. The same principle applies to those who are not part of the criminal justice system. Librium is a useful tool for drug withdrawal, but it cannot, and should not, be used in isolation. With careful prescribing and supervision, Librium can control the anxiety symptoms of drug withdrawal and then prepare the patient to receive the therapy needed to stay clear of the temptation to abuse alcohol again.
Alcohol withdrawal syndrome is the clinical diagnosis that describes how severe the effects of the process are. Alcohol withdrawal was the suspected cause of death of singer Amy Winehouse, who died at age 27 in July 2011. As a benzodiazepine, Librium gains its effectiveness from boosting the effects of the GABA neurotransmitter across the central nervous system. This neurotransmitter regulates electrical activity in the brain.