Librium, pharmaceutically known for its generic name Chlordiazepoxide hydrochloride, is a potent anxiolytic medicine classified under the class of Benzodiazepine. Depending on where it is being used or on the adjunct substance mixed with it during administration, Librium has garnered few street names. Blue bombs, Nerve Pill, Trank, Downer, Blue, Ruffles, and L are few of the street names given to it but are not being used in the field of medicine. Chlordiazepoxide HCl has other chemical equivalents like Chlordiazepoxide hydrobromide, Chlordiazepoxide monohydrochloride, Chlordiazepoxide perchlorate, Chlorzepid, and Methanamine Diazepoxide, and is available in the market under the brand names, A-poxide, Chlordiazachel, H-Tran, Libreleas, Libritabs, Lygen, Mitran, Poxi, and Librax. Formulated by Hoffmann-La Roche Inc., it is categorized as a regulated medicine, prescribed by physicians who have obtained special license to prescribe regulated medicine and strictly dispensed by pharmacists.
Librium is used as a relief from anxiety and as an aid for acute alcohol withdrawal symptoms through its relaxing effects.
The drug’s active ingredient is a water-soluble, white, crystalline compound that is highly unstable to sunlight. It is sold in the market as a capsule for its dosage form with dosage strengths of 5 mg, 10 mg, and 25 mg. The different dosage strengths have distinct features based on their capsule color. Such in the case of 5 mg strength which is encapsulated inside a yellow, blue or green capsule. The 10 mg strength is encapsulated inside a “Yellow, Blue and Red” or “Yellow, Blue and Green” capsule. While the 25 mg strength is encapsulated inside a “Yellow and Green” or “Yellow and Blue” capsule.
Chlordiazepoxide, being a capsule, has pharmaceutical excipients. The inactive ingredients used to hold the medicine to ensure safety, quality, efficacy, and efficiency of the medicine. Its water-soluble shell is mixed with methyl and propyl parabens, and potassium sorbate to ensure that it will be free from developing yeast and mold. It also contains Talc as lubricant, corn starch as binder and lactose as diluent. Knowing these components is equally important as to knowing the entirety of the drug as this information may help your physician and pharmacist know whether you may develop an allergic reaction.
Clinical Indications of Librium
Before, when Librium has not been labeled as a regulated drug, it was both used for medical and recreational purposes. However, with the advent of drug addiction, the regulation of its availability became the reason why it is not used for recreational purposes now. A few of its indications are relief of anxiety; agent used for acute alcohol withdrawal symptoms; and relief for seizures, insomnia, muscle tensions, and irritable bowel movement symptoms. Likewise, it is also used to relieve fear before a person undergoes surgery.
How Librium works
Given the fact that it is a potent medicine, how does this minute substance able to cast its effect to the patients?
The human brain heavily depends on brain signals which are called neurotransmitters to relay a message. Neurotransmitters vary from each other, likewise, their effects. One of the important neurotransmitters is the Gamma-Aminobutyric Acid (GABA), a chief inhibitory neurotransmitter that relaxes the neural activities. It does so by increasing the chloride ion influx inside the cell, thus, relaxing the nerve and eventually the brain.
Librium, on the other hand, potentiates the effect of GABA in the brain. It specifically binds on the beta subunit found on the receptor where GABA produces its relaxation effect. By that virtue, it lengthens the duration of GABA binding to its active site eventually making the nervous system in a relaxed state.
Dosage and Dose Duration of Librium
The dose and duration of drug regimen vary depending on the disorder or disease of the patient, and of course with the jurisdiction of the licensed physician.
Generally, in order to experience the maximum therapeutic effect of this benzodiazepine drug, the medication must be maintained for approximately four months.
Detection of Librium
When one has to undergo drug testing, Chlordiazepoxide and its metabolite are detectable on different tissues and fluids. In the blood, its presence lasts up until 6-48 hours. In the urine, its presence lasts up to 1-6 weeks. While in the saliva, its presence lasts up until 1-10 days. And in the hair, its presence lasts for 90 long whooping days.
Precautions and Adverse Drug Reactions
Librium, albeit shows lesser adverse drug reactions compared to other benzodiazepines, is dangerous for two primary reasons. First, patients may develop drug tolerance, meaning, the longer the patient is exposed to the drug, the higher dose it needs to take in order to deliver the same action of the initial dose given. And second, it is subject to misuse and abuse.
When combined with other substances such as alcohol, sedatives, antidepressants and illicit drugs such as heroin and cocaine, health damages may be the result. Some of the health damages are as follows: verbal dysfunction; seizures; extreme sleepiness; hypotension; difficulty in breathing; and extreme muscle weakness. Continued high-dosage intake of the drug may increase the risk of developing dementia.
Sleepiness, nausea, headache, bleary eyes and constipation are the common adverse drug reactions of Librium. Short term effects of Librium are relaxed body; drowsiness; and relief from anxiety. While the long-term effects are dementia; apathy; suicidal behavior; poor focus; depression; irritability; headache; gastrointestinal pain; liver failure; and uncontrolled body movements.
Overdose and Treatment
OVERDOSE
Chlordiazepoxide overdose usually occurs when one intakes more than what is prescribed or above the general dose. Excessive intake due to recreational purposes causes overdose as well.
One has to be well oriented and keen on spotting the signs of Chlordiazepoxide overdose. Some of the signs are as follows: short breath; bleary vision; arrhythmia; disorientation; gradual memory loss; stomach cramps; and nausea.
TREATMENT
There are many approaches and factors to consider in addressing Librium overdose. These factors are important since they will be the deciding agents to which intervention shall be made during an emergency case such as this.
PRIMARY ANTIDOTE
Flumazenil is the primary antidote as it will antagonize the effects of Chlordiazepoxide.
WHEN DRUG HAS NOT BEEN ABSORBED YET IN THE INTESTINE – administration of activated charcoal is useful. The activated charcoal will act as an organic magnet so that the Chlordiazepoxide moiety will no longer be absorbed in the small intestine. Next, performing stomach lavage will be helpful in taking away the moiety out from the stomach, thus, no further absorption to the circulatory system may occur.
WHEN DRUG HAS REACHED THE SYSTEMIC CIRCULATION – Performing dialysis will be helpful in separating the toxic dose out from the blood. Administration of intravenous fluids and monitoring vital signs are to be performed as well.
WHEN ADDRESSING DRUG-INDUCED HYPOTENSION – Levarterenol and Metaraminol will be used to address hypotension.
Withdrawal and Addiction Treatment
A person who abuses the said medicine for more than four weeks may become dependent on the substance. Thus, sudden cessation of the drug may lead the person to experience withdrawal symptoms.
Several withdrawal symptoms are as follows: difficulty in sleeping; muscle pain; rapid breathing action; loss of appetite; extreme weight loss; excessive sweating; irritability; inability to focus; and frequent headaches.
TREATMENT
The first thing to be done when addiction is detected from the person taking the said medicine is to consult the clinician or physician. However, usually, there are different methods used to address the addiction of the patient.
- Medicine – Clonazepam, a benzodiazepine will cure seizure, panic attacks, and anxiety. Phenobarbital, a barbiturate, will minimize seizures and anxiety. Buspirone, a serotonin receptor agonist, elevates the mood. Carbamazepine relaxes the brain and reduces anxiety. And Imipramine, a tricyclic antidepressant, cures depression by inhibiting the reuptake of the neurotransmitters responsible for good mood.
- Reward System – A contingency management plan where sets of rewards will be given to the patient who will avoid the substance. This is a positive reinforcement to address addiction.
- Cognitive Behavioral Therapy – A treatment process seeking to determine the variables causing drug abuse, risk reduction methods and enhancing coping mechanism.
- Recovery Group- A community-based plan which allows the patient to meet other victims and have a sharing about their experiences and success in gradually overcoming their addiction.
