Makindo Medical Notes

📘 About

• Always check the BNF entry (and local Trust alcohol withdrawal protocols) for the most up-to-date prescribing advice.
• Chlordiazepoxide is a long-acting benzodiazepine widely used in alcohol withdrawal and detoxification regimens.

⚙️ Mode of Action

• Enhances the effect of GABA at the GABA_A receptor, producing anxiolytic, sedative, anticonvulsant, and muscle relaxant effects.
• In alcohol withdrawal, it substitutes for ethanol’s CNS depressant action, preventing withdrawal seizures and delirium tremens.

📅 Example Detoxification Regimen (titrate to patient)

Note: This is an example only. Actual doses are titrated by CIWA-Ar score and clinical severity. Higher starting doses (e.g. 20–30 mg QDS or more) are often required in severe dependence.

💡 Always co-prescribe Pabrinex (parenteral thiamine) to prevent Wernicke’s encephalopathy. 📊 Monitor using CIWA-Ar scoring where available to guide dose titration.

🍺 Alcohol Withdrawal

• Symptoms typically start 12–48 h after last alcohol and may last 5–7 days.
• Chlordiazepoxide reduces agitation, prevents seizures, and lowers risk of delirium tremens.

🔀 Interactions

• See BNF for full list (notable: alcohol, opioids, other CNS depressants).

⚠️ Cautions

• Monitor for oversedation, respiratory depression, or delirium.
• Use with caution in hepatic impairment (risk of accumulation and encephalopathy).
• Elderly and frail patients are more sensitive → use lower doses.

🚫 Contraindications

• See BNF (e.g. respiratory depression, severe hepatic insufficiency, myasthenia gravis).

💥 Side Effects

• Respiratory depression.
• Drowsiness, confusion, ataxia, amnesia.
• Dependence and withdrawal risk with prolonged use.

📖 References

• BNF – Chlordiazepoxide
• NICE Clinical Knowledge Summaries – Alcohol withdrawal

📝 Revisions

• Updated for teaching clarity – August 2025