Chlordiazepoxide alcohol withdrawal

Benzodiazepines are the evidence-based treatment of choice for uncomplicated alcohol withdrawal.17 Barbiturates are not recommended because of their low therapeutic index due to respiratory depression. Some of the anticonvulsants have also been used to treat uncomplicated withdrawal (particularly car-bamazepine and sodium valproate). Although anticonvulsants provide an alternative to benzodiazepines, they are not as well studied and are less commonly used. The most commonly employed benzodiazepines are chlordiazepoxide, diazepam, lorazepam, and oxazepam. They differ in three major ways (1) their pharmacokinetic properties, (2) the available routes for their administration, and (3) the rapidity of their onset of action due to the rate of gastrointestinal absorption and rate of crossing the blood-brain barrier. 

Chlordiazepoxide Librium Oral Long 15-100 Anxiety disorders, alcohol withdrawal... 

Benzodiazepines. Like the barbiturates, benzodiazepines bind to the GABA receptor and are therefore cross-tolerant with alcohol. As a result, they also make suitable replacement medications for alcohol and are widely used for alcohol detoxification. Theoretically, any benzodiazepine can be used to treat alcohol withdrawal. However, short-acting benzodiazepines such as alprazolam (Xanax) are often avoided because breakthrough withdrawal may occur between doses. Intermediate to long-acting benzodiazepines including chlordiazepoxide (Librium), diazepam (Valium), oxazepam (Serax), lorazepam (Ativan), and clonazepam (Klonopin) are more commonly utilized. 

All benzodiazepines are indicated in obsessive compulsive disorders. Diazepam and lorazepam are effective in status epilepticus, whereas chlordiazepoxide is indicated in alcohol withdrawal. 

Diazepam is used for the control of anxiety and tension, the relief of muscle spasms, and the management of acute agitation during alcohol withdrawal, but it itself may be habit-forming. Chlordiazepoxide has similar uses and its synthesis is somewhat analogous to diazepam. Flurazepam is a hypnotic, useful for insomnia treatment. It is reported to provide 7-8 hr of restful sleep. 

Acute alcohol withdrawal For the symptomatic relief of acute alcohol withdrawal (clorazepate, chlordiazepoxide, oxazepam) may be useful in symptomatic relief of acute agitation, tremor, impending or acute delirium, tremens, and hallucinosis (diazepam). 

B. Chlordiazepoxide, through its metabolites, has a relatively long biological half-life. It will prevent many of the severe symptoms of acute alcohol withdrawal. Buspirone is not a sedative and will not suppress alcohol withdrawal. The other agents have sedative properties and could potentially suppress alcohol withdrawal but each has a much shorter biological half-life than chlordiazepoxide. 

File SE, Zharkovsky A, Hitchcott PK. Effects of nitrendepine, chlordiazepoxide, flumazenil and baclofen on the increased anxiety resulting from alcohol withdrawal. Prog Neuropsychopharmacol Biol Psychiatry 1992 16 87-93. 

BZDs such as chlordiazepoxide (Librium) or diazepam (Valium) may be prescribed to treat anxiety, seizures, acute stress reactions, and panic attacks, or to alleviate the side effects of drug or alcohol withdrawal. Those BZDs with a more sedating effect, such as estazo-lam (ProSom) or triazolam (Halcion), may be prescribed for short-term treatment of sleep disorders. However, the newer generation of non-BZD agents—zolpidem (Ambi-en) and (Sonata)—are less potentially addictive hypnotic drugs than the BZDs. 

Seizures Clonazepam [kloe NA ze pam] is useful in the chronic treatment of epilepsy, whereas diazepam is the drug of choice in terminating grand mal epileptic seizures and status epilepticus (see p. 149). Chlordiazepoxide [klor di az e POX ide], clorazepate [klor AZ e pate], diazepam, and oxazepam [ox A ze pam] are useful in the acute treatment of alcohol withdrawal. 

The correct answer = B. It is important to treat the seizures associated with alcohol withdrawal. Benzodiazepines, such as chlordiazepoxide, diazepam or or the shorter-acting lorazepam, are effective in controlling this problem. They are less sedating than pentobarbital or phenytoin. 

This fivefold clinical activity is possessed, to a greater or lesser extent, by all benzodiazepines in current clinical use. The properties of benzodiazepines make them ideally useful for managing anxiety (e.g. diazepam, chlordiazepoxide, lorazepam) insomnia (e.g. diazepam, temazepam, nitrazepam, loprazolam, flurazepam, lormetazepam) epilepsy (e.g. clobazam, diazepam, lorazepam) sports injuries where muscle relaxation is required (e.g. diazepam) and as premedications prior to surgery (e.g. midazolam, lorazepam). The benzodiazepines have a number of other uses, including management of alcohol withdrawal syndrome (chlordiazepoxide, diazepam) and restless legs (clonazepam). Short... 

Long-acting benzodiazepines (e.g. diazepam and chlordiazepoxide) are used to attenuate alcohol withdrawal symptoms but they also have a dependence potential. To minimise the risk of dependence, administration should be for a limited period only (e.g. chlordiazepoxide 20 mg 4 times daily, gradually reducing to zero over 7-14 days). Mild alcohol withdrawal symptoms may be treated with a lower starting dose, such as 15 mg four times a day. In all cases, the patient should be counselled about the proposed length of the treatment course. Benzodiazepines should not be prescribed if the patient is likely to continue drinking alcohol. 

Chlordiazepoxide, which has a long duration of action (t 2 = 10-25 hours), is useful for the management of alcohol withdrawal and is arguably better tolerated than other benzodiazepines when used for this indication. As with diazepam, loading doses are possible and simplify clinical management. 

I Fixed-Schedule Therapy. Over the years, benzodiazepines given regularly at a fixed dosing interval have been considered the gold standard therapy for alcohol withdrawal. Chlordiazepoxide 50 to 100 mg oraUy every 6 hours for 1 day followed by 2 days at 25 to 50 mg every 6 hours is known to prevent dehrium tremens and seizures. 

Chlordiazepoxide Clobazam Anxiety disorders, management of alcohol withdrawal, anesthetic premedication... 

Chlordiazepoxide is indicated in the management of anxiety disorders for the short-term relief of symptoms of anxiety for symptoms of acute alcohol withdrawal and for preoperative apprehension and anxiety. 

Chlordiazepoxide (librium, others) Oral, IM, IV Anxiety disorders, management of alcohol withdrawal, anesthetic premedication Long-acting and self-tapering because of active metabolites 10+3.4 50-100, qd-qid ... 

Chlordiazepoxide Diazepam Midazolam Phenobarbital 54. Benzodiazepines are LEAST effective in (A) Alcohol withdrawal syndromes Balanced anesthesia regimens Initial management of phencyclidine overdose Obsessive-compulsive disorders Social phobias... 

NICE (2010) Alcohol use disorders sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal NICE, England. 

Withdrawal from long-term high-dose use of alcohol or sedative-hypnotic drugs can be life threatening if physical dependence is present. Benzodiazepines, such as chlordiazepoxide Librium) and diazepam Valium), are sometimes used to lessen the intensity of the withdrawal symptoms when alcohol or sedative-hypnotic drug use is discontinued. Benzodiazepines are also employed to help relieve the anxiety and other behavioral symptoms that may occur during rehabilitation. 

Many alcohol-dependent patients manage their withdrawal outside of the hospital when they have only mild symptoms and are in generally good health. Very often these patients will visit their primary care physician, seeking a short course of benzodiazepines (such as diazepam or chlordiazepoxide) for a few days, as well as some prescription-strength vitamins and thiamine to assist in their withdrawal and recovery. It is critical that a responsible adult monitors these patients around the clock to be sure that they are not developing confusion, unstable blood pressure, or other vital signs and to provide essential support for the detoxification process. 

Chlordiazepoxide hydrochloride Treatment of initial or acute withdrawal symptoms caused by the withdrawal of alcohol from persons habituated to it Oral... 

During acute withdrawal from alcohol, the intravenous administration of diazepam is recommended, usually followed by chlordiazepoxide given orally. 

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