Alfentanil
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Drug reference
Chlordiazepoxide hydrochloride
Benzodiazepine · Anxiolytic
Also known as Chlordiazepoxide, Librium
BenzodiazepineAnxiolytic
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AlfentanilSevereTextbookG&G 14e
- BuprenorphineSevereTextbookG&G 14e
- CodeineSevereTextbookG&G 14e
- FentanylSevereTextbookG&G 14e
Mechanism
Chlordiazepoxide hydrochloride is the water-soluble salt form of chlordiazepoxide, the first benzodiazepine. It acts as a positive allosteric modulator of the GABA-A receptor complex, binding at the α/γ subunit interface and increasing the frequency of chloride channel opening in response to GABA. The hydrochloride salt provides improved bioavailability for oral and parenteral administration, with a long duration of action due to active metabolites including desmethylchlordiazepoxide and demoxepam.
Indications
Short-term use in anxietyTreatment of alcohol withdrawal in moderate dependenceTreatment of alcohol withdrawal in severe dependence
Dosing
- Adult
- For anxiety: 10 mg 3 times a day, increased if necessary to 60–100 mg daily in divided doses. For alcohol withdrawal in moderate dependence: 10–30 mg 4 times a day, dose to be gradually reduced over 5–7 days. For alcohol withdrawal in severe dependence: 10–50 mg 4 times a day and 10–40 mg as required for the first 2 days, dose to be gradually reduced over 7–10 days.
- Renal adjustment
- Start with small doses in severe impairment.
- Hepatic adjustment
- Manufacturer advises dose reduction to max. 50% of the usual dose in mild to moderate impairment.
- Geriatric
- For anxiety: 5 mg 3 times a day, increased if necessary to 30–50 mg daily in divided doses. For debilitated patients, use elderly dose.
- Max dose
- 250 mg per day
Contraindications
- Chronic psychosis
- Respiratory depression
- Bone marrow disorders
- Erectile dysfunction
- Leucopenia
- Menstrual disorder
- Skin eruption
- Thrombocytopenia
Side effects
Common
Appetite decreasedConcentration impairedConstipationDermatitisDry mouthMemory lossMovement disordersSexual dysfunctionWeight changesMenstruation irregularAppetite increasedGait abnormalIncreased risk of fallLevel of consciousness decreasedSaliva altered
Serious
- Angioedema
- Autonomic dysfunction
- Hepatic disorders
- Hyperprolactinaemia
- Peripheral oedema
- Photosensitivity reaction
- Suicide
- Thinking abnormal
- Suicide attempt
Pregnancy & lactation
Lactation
Benzodiazepines are present in milk, and should be avoided if possible during breast-feeding.
Drug interactions
Buprenorphine
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Codeine
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Fentanyl
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Hydrocodone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Methadone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Methylnaltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Morphine
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Nalmefene
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naloxone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Other Cns Depressants
Severe
Textbook
Typically fatal if combined in overdose.
Use with extreme caution; avoid if possible.
Source: G&G 14e
Related guidelines
Other Benzodiazepine drugs
Ask House about Chlordiazepoxide hydrochloride
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Sources: Katzung·Verified: 2026-05-10 · House clinical team