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Librium

Chlordiazepoxide (marketed under the trade name Librium®) is a hypnotic drug which is a benzodiazepine derivative. It has sedative, anxiolytic and skeletal muscle relaxant properties. more...

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History

Chlordiazepoxide was the first benzodiazepine to be synthesized and made commercially available. It was an accidental discovery made by Leo Sternbach of Roche Pharmaceuticals in 1960. It has a medium to long half life.

Sternbach later went on to develop diazepam, better known as Valium, in 1963. The huge success of Valium made Roche the market leader in benzodiazepine products, and the company went on to develop and market nitrazepam in 1965 and later flurazepam and flunitrazepam in 1975.

Other drug companies soon jumped on board the benzodiazepine band wagon, with Wyeth's lorazepam and Upjohn (now Pfizer)'s alprazolam.

As prescriptions for benzodiazepines sky-rocketed through the late 1960s and 1970s, the problem of dependency began to emerge. However, chlordiazepoxide is still a useful treatment for patients suffering from acute anxiety. It is still manufactured and prescribed today, along with a wide variety of other benzodiazepines, all of which have similar properties.

Pharmacology

Chlordiazepoxide is believed to act on the GABA_A receptor, thereby producing inhibitory effects similar to the other benzodiazepines.

Indications

Chlordiazepoxide is indicated for the treatment of insomnia, anxiety and panic attacks. It has also been used as a treatment for acute alcohol or opiate withdrawl.

Dosage

Chlordiazepoxide is available in dosages of 5mg, 10mg and 25mg.

Side Effects

Common side effects of chlordiazepoxide include:

Drowsiness
Depression
Impaired motor function
- Impaired coordination
- Impaired balance
- Dizziness
Nervousness
Anterograde amnesia (especially pronounced in higher doses)

Contraindications

Use of chlordiazepoxide should be avoided in individuals with the following conditions:

Myasthenia gravis
Acute intoxication with alcohol, narcotics, or other psychoactive substances
Ataxia
Severe hypoventilation
Acute narrow-angle glaucoma
Severe liver deficiencies (hepatitis and liver cirrhosis decrease elimination by a factor of 2)
Severe sleep apnea
Hypersensitivity or allergy to any drug in the benzodiazepine class

Overdose

An individual who has consumed too much chlordiazepoxide will display one or more of the following symptoms:

Somnolence (difficulty staying awake)
Mental confusion
Hypotension
Hypoventilation
Impaired motor functions
- Impaired reflexes
- Impaired coordination
- Impaired balance
- Dizziness
- Muscle Weakness
Coma

In animal models, the oral LD₅₀ of chlordiazepoxide is 537 mg/kg.

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Clinical quiz
From American Family Physician, 2/1/05

Clinical is for one year Quiz questions are based on selected articles in this issue of American Family Physician. Answers appear in this issue. AFP has been reviewed by the American Academy of Family Physicians as having content acceptable for Prescribed credit. Term of approval from the beginning distribution date of January 2005. This issue has been reviewed and is acceptable for up to 3.5 Prescribed credits. One half of one credit conforms to AAFP criteria for evidence-based CME (EB CME) clinical content. The amount of CME has been doubled to reflect two-for-one credit for the EB CME portion only. When reporting CME credits, AAFP members should report total Prescribed credits earned for this activity. It is not necessary for members to label credits as EB CME for reporting purposes.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians.

The AAFP designates this educational activity for a maximum of 3.5 Category 1 credits toward the American Medical Association Physician's Recognition Award (AMA/PRA). Each physician should claim only those credits that he or she actually spent in the activity.

AAFP Credit

Each copy of AFP contains a Clinical Quiz answer card. AAFP members may use this card to obtain the designated number of Prescribed credit hours for the year in which the card is postmarked.

AMA/PRA Category 1 Credit

AAFP members who satisfy the Academy's CME requirements are automatically eligible for the AMA/PRA.

Physicians who are not members of the AAFP are eligible to receive the designated number of credits in Category 1 of the AMA/PRA on completion and return of the Clinical Quiz answer card. AFP keeps a record of AMA/PRA Category 1 credits for nonmember physicians. This record will be provided on request; however, nonmembers are responsible for reporting their own Category 1 CME credits when applying for the AMA/PRA or other certificates or credentials.

For health care professionals who are not physicians and are AFP subscribers, a record of CME credit is kept by AAFP and will be provided to you on written request. You are responsible for reporting CME credits to your professional organization.

NOTE: The full text of AFP is available online (http://www.aafp.org/afp), including each issue's Clinical Quiz. The table of contents for each online issue will link you to the Clinical Quiz. Just follow the online directions to take the quiz and, if you're an AAFP member, you can submit your answers for CME credit.

Instructions (1) Read each article, answer all questions on the quiz pages, and transfer your answers to the Clinical Quiz answer card (bound into your copy of AFP). This will help you avoid errors and permit you to check your answers against the correct answers. (2) Mail the Clinical Quiz answer card within one year (by February 1, 2006). The bar code on the answer card contains your identification for CME credit hours. Before beginning the test, please note: Each Clinical Quiz includes two types of questions: Type A and Type X. Type A questions have only one correct answer and may have four or five choices. Here is a typical Type A question:

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