Benzodiazepine
Potentiates GABA-A receptor-mediated inhibitory neurotransmission, producing anxiolytic, sedative, muscle relaxant, and anticonvulsant effects.
Acute alcohol withdrawal, short-term relief of anxiety symptoms
Benzodiazepine taper, catatonia, preoperative anxiety
Oral tablets, liquid
5–25 mg p.o. three to four times daily; higher doses initially for alcohol withdrawal with gradual taper
Varies widely by indication; commonly 30–200 mg/day divided doses for alcohol withdrawal
Chlordiazepoxide is extensively metabolized in the liver primarily by CYP3A4 and CYP2C19 enzymes to active metabolite, which contribute to its long half-life (5–30 hours) and prolonged clinical effects. The active metabolites have half-lives ranging from 36 to 200 hours, leading to accumulation with repeated dosing and smoother withdrawal profiles.
Sedation, impaired coordination, slurred speech, confusion
Respiratory depression, paradoxical agitation, dependence, withdrawal seizures
Clinical monitoring for sedation, respiratory status during withdrawal treatment, hepatic function if indicated, fall risk assessment especially in elderly
Risk of profound sedation, respiratory depression, coma, and death when used with opioids. Risk of dependence, misuse, and withdrawal with prolonged use.
Chlordiazepoxide is often used in individuals with alcohol use disorder and seizure risk, including those with traumatic brain injury (TBI) or underlying cognitive conditions. It should be avoided in individuals with hepatic impairment and used cautiously in the elderly due to fall risk and prolonged sedation