Withdrawal reactions from chlordiazepoxide (“Librium”)

Summary

Ten of 11 patients abruptly switched to placebos after several months of high daily doses (300–600 mg, 8–20 times the usual therapeutic range) of chlordiazepoxide experienced new symptoms and signs soon after. Depression, aggravation of psychoses, agitation, insomnia, loss of appetite, and nausea appeared between two and eight days following abrupt withdrawal. Two patients had seizures at seven and eight days. A third patient, not in the withdrawal study, had a seizure twelve days after discontinuation of a 300 mg daily dose. Plasma levels of drug indicated a half-life of approximately forty-eight hours following discontinuation of chronic high doses. Minor electroencephalographic abnormalities (mainly slowing) were produced by chronic administration of these exceedingly high doses. If large doses of chlordiazepoxide are used, the drug should not be abruptly discontinued.