Chlordiazepoxide

Chlordiazepoxide - is a benzodiazepine used to attenuate alcohol withdrawal symptoms, but also has a dependence potential. The risk of dependence is minimised by limiting the duration of treatment and reducing the dose gradually over 7–14 days. It is available as 5-mg and 10-mg capsules or tablets.

Uses:
Alcohol withdrawal
Restlessness and agitation

Contraindications:
Alcohol-dependent patients who continue to drink
Obstructive sleep apnoea
Severe hepatic impairment

Administration:
• Alcohol withdrawal
Orally:

Day	Dose (mg) at:
	08:00 h	12:00 h	18:00 h	22:00 h
1	30	30	30	30
2	25	25	25	25
3	20	20	20	20
4	10	10	10	10
5	5	5	5	5
6	–	5	5	5
7	–	–	5	5
8	–	–	–	5

• Restlessness and agitation
Orally: 10–30 mg 3 times daily

How not to use chlordiazepoxide:
Prolonged use (risk of dependence) Abrupt withdrawal

Adverse effects:
Muscle weakness
Confusion
Ataxia
Hypotension

Cautions:
Concurrent use of other CNS depressants will produce excessive sedation
Cardiac and respiratory disease – confusion may indicate hypoxia
Hepatic impairment – sedation can mask hepatic coma (avoid if severe)
Renal impairment – increased cerebral sensitivity

Organ failure:
Hepatic: reduced clearance with accumulation. Can precipitate coma
Renal: increased cerebral sensitivity