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Chlordiazepoxide
📘 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 GABAA 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)
| Day | Dose | Route |
|---|---|---|
| Day 1 | 20 mg QDS | PO |
| Day 2 | 20 mg TDS | PO |
| Day 3 | 10 mg QDS | PO |
| Day 4 | 10 mg TDS | PO |
| Day 5 | 5 mg QDS | PO |
| Day 6 | 5 mg TDS | PO |
| Day 7 | 5 mg BD | PO |
| Day 8 | Stop | – |
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
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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