Librium, or Chlordiazepoxide for Alcohol Withdrawal

Librium (Chlordiazepoxide) for Alcohol Withdrawal

The use of medication to manage symptoms of withdrawal from alcohol dependence is frequently necessary. I often get asked what medications Executive Home Detox uses to manage withdrawal symptoms in alcohol detoxification. In general, most prescribing physicians and nurse practitioners use a benzodiazepine to manage withdrawal symptoms.  

Chlordiazepoxide, or Librium, is one of the first benzodiazepines created. Librium is a long acting benzodiazepine. It comes only in pill form and in strengths of 10 mg and 25 mg. Many physicians prefer to use Librium for Detox Physician and Detox Team because it is well known to the physician, long acting, and stays in the body for a longer time than other benzodiazepines, thus has the potential to offer longer protection against the risk of seizures and other withdrawal symptoms.

Chlordiazepoxide or Librium should only be used under the supervision of a physician or nurse practitioner. The information in this post is meant for information purposes only. 

Librium, like other benzodiazepines, has the potential for dependence or abuse. The reality is that it is rarely abused and it is prescribed almost solely for short periods of time so dependence does not occur.

Librium is also sedating, and depending on the recipient's liver function, can contribute to a syndrome called delirium. Due to the sedation and delirium, Librium used for alcohol detox is best monitored or supervised by others during the alcohol home detox.

Prior to the start of Librium, the physician will strongly consider ordering lab studies that include Liver Function Tests. Many alcohol dependent clients have a long history of alcohol use and abuse and their Livers may be impaired. Librium is contraindicated in clients with impaired liver function and another benzodiazepine will usually be ordered.

EHD and nurses who work for EHD are very familiar with Librium, it's mode of action, and it's possible side effects.  

Delirium Tremens and Alcohol Seizures

Alcohol withdrawal can be very dangerous due to the possibility of seizures and the possibility of delirium tremens. Seizures and delirium tremens or DT's can both be life threatening. Seizures are more common and better known to the general public. DT's are less common but have a higher lethality than seizures.
Alcoholic Seizures: Seizures can occur in anyone who is physically dependent on alcohol and who stops drinking. The brain becomes dependent on alcohol over a period of time and when it is taken away precipitiously, the brain may react by having a grand mal seizure.

Delirium Tremens:According to the National Institute of Health; "Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or neurological changes. Delirium tremens can occur after a period of heavy alcohol drinking, especially when the person does not eat enough food.It may also be triggered by head injury, infection, or illness in people with a history of heavy alcohol use. It is most common in people who have a history of alcohol withdrawal. It is especially common in those who drink the equivalent of 4 - 5 pints of wine or 7 - 8 pints of beer (or 1 pint of "hard" alcohol) every day for several months. Delirium tremens also commonly affects those who have had a history of habitual alcohol use or alcoholism for more than 10 years."

Additionally, according to the NIH:

"Symptoms most commonly occur within 72 hours after the last drink, but may occur up to 7 - 10 days after the last drink. Symptoms may get worse rapidly, and can include:

• Body tremors
• Mental status changes
  • Agitation, irritability
  • Confusion, disorientation
  • Decreased attention span
  • Decreased mental status
    • Deep sleep that persists for a day or longer
    • Stupor, sleepiness, lethargy
    • Usually occurs after acute symptoms
  • Delirium (severe, acute loss of mental functions)
  • Excitement
  • Fear
  • Hallucinations (such as seeing or feeling things that are not present are most common)
  • Highly sensitive to light, sound, touch
  • Increased activity
  • Mood changes rapidly
  • Restlessness, excitement"

Delirium tremens is a serious medical emergency and can result in death. Signs may include:

• Heavy sweating
• Increased startle reflex
• Irregular heartbeat
• Problems with eye muscle movement
• Rapid heart rate
• Rapid muscle tremors

Treatment must be given at a hospital immediately in the event of seizures or delirium tremens.

The early recognition of alcohol withdrawal and the early treatment with appropriate medications will decrease the likelihood of alcohol seizures and delirium tremens. Executive Home Detox has not had a client develop seizures during an alcohol detox. We attribute this to early intervention with appropriate medications.

Alcohol withdrawal

Alcohol withdrawal is an actual diagnosis contained in the American Psychiatric Association's Diagnostic and Statistical Manual - IV (DSM IV). Alcohol withdrawal can be mild, moderate, or severe. The moderate and severe withdrawal may require intense medical treatment.

Alcohol consumption that is heavy and prolonged will cause a withdrawal syndrome if alcohol consumption is reduced or stopped altogether. The withdrawal syndrome usually starts six to twenty-four hours after the last drink and may start prior to the blood alcohol level returning to zero.

The DSM - IV requires that two of the following criteria be met to diagnose someone with Alcohol Withdrawal who has been consuming alcohol in a heavy and prolonged manner:

1. Sweating, also known as diaphoresis. Most people who complain of sweating complain of night sweats. 
2. Pulse rate greater than 100. This may be referred to Tachycardia,
3. Increased hand tremor.
4. Insomnia or sleeplessness. 
5. Nausea or vomiting.
6. Transient (on and off) visual, tactile, or auditory hallucinations or illusions.
7. Psychomotor agitation
8. Anxiety
9. Grand mal seizures

A further requirement is the symptoms above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. A further requirement is the symptoms are not caused by another medical concern (ie Parkinsons) or another mental disorder.

A way to quantify or measure the withdrawal symptoms and place some type of severity scale to the symptoms is to use the Clinical Institute Withdrawal Assessment - Alcohol, or CIWA. Executive Home Detox does use the CIWA scale when assessing clients during an alcohol detox. The expert nurse also monitors vital signs, specifically Temperature, Blood Pressure, Pulse rate, and Respirations.

A future blog will discuss the CIWA in greater detail.

The Principles of Addiction Medicine, Fourth Edition was utilized as a reference for much of the information above.