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Chlordiazepoxide, sold under the brand name Librium among others, is a sedative and hypnotic medication of the benzodiazepine class. It is used to treat anxiety, insomnia and symptoms of withdrawal from alcohol, benzodiazepines, and other drugs. Chlordiazepoxide has a medium to long half-life, while its active metabolite has a very
Signs and symptoms of alcohol withdrawal occur primarily in the central nervous system. The severity of withdrawal can vary from mild symptoms such as insomnia, trembling, and anxiety to severe and life-threatening symptoms such as alcoholic hallucinosis, delirium tremens, and autonomic instability.
Alcohol detoxification (also known as detox) is the abrupt cessation of alcohol intake in individuals that have alcohol use disorder. This process is often coupled with substitution of drugs that have effects similar to the effects of alcohol in order to lessen the symptoms of alcohol withdrawal. When withdrawal does occur, it results in ...
Withdrawal from benzodiazepines should be gradual as abrupt withdrawal from high doses of benzodiazepines may cause confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens. Abrupt withdrawal from lower doses may cause depression, nervousness, rebound insomnia, irritability, sweating, and diarrhea. [10]
A randomized, double blind trial published in JAMA in 1994 [5] showed that management for alcohol withdrawal that was guided by the CIWA scale resulted in decreased treatment duration and total use of benzodiazepines. The goal of the CIWA scale is to provide an efficient and objective means of assessing alcohol withdrawal.
Clomethiazole is particularly toxic and dangerous if overdosed and is potentially fatal. Alcohol multiplies the effect. As the drug can be fatal in high doses, prescribing clomethiazole for the management of alcohol dependence outside of a controlled environment, for example a hospital, is not recommended, especially because there are much less toxic alternatives, such as diazepam.
[24]: 275 The benzodiazepines with a longer half-life make detoxification more tolerable, and dangerous (and potentially lethal) alcohol withdrawal effects are less likely to occur. On the other hand, short-acting benzodiazepines may lead to breakthrough seizures , and are, therefore, not recommended for detoxification in an outpatient setting.
[7] [8] Oxazepam is used for the treatment of anxiety, [9] [10] insomnia, and to control symptoms of alcohol withdrawal syndrome. It is a metabolite of diazepam , prazepam , and temazepam , [ 11 ] and has moderate amnesic , anxiolytic , anticonvulsant , hypnotic , sedative , and skeletal muscle relaxant properties compared to other benzodiazepines.