HWN Suggests

Librium

Librium's discovery was partly accidental. Leo Sternbach, a researcher in the New Jersey laboratory of Hoffmann-La Roche, had been looking for a new drug to replace the highly addictive barbiturates of the 1950s. He was testing derivatives of a class of compounds, benzoheptoxdiazines, which he had worked with years before. He discovered, however, that the compounds he was using had only six-membered rings, not seven-, and the 40 derivatives he made had no biological activity. He treated one derivative with methylamine and just stored the resulting white crystalline powder on a shelf.

A couple of years later, this compound--which might easily have been thrown out with the other useless…

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Articles of Interest

'Amy had prescription drug Librium in her system when she died of a seizure', says father Mitch Winehouse

In an interview on Anderson Cooper's new talk show, Mitch also revealed that Amy had the prescription medication Librium, which is used to fight anxiety and withdrawal symptoms of alcoholism, in her system when she died.

Medicine: Report on Librium

The drug he had been using: methaminodia-zepoxide, trade-named Librium, recently marketed with much fanfare by New Jersey's Roche Laboratories (TIME, March 7) and now giving hot competition to meprobamate (Equanil, Miltown). The maker's claim: Librium acts by allaying rage and anxiety reactions without causing drowsiness or depressing mental activity. The fact was that Librium, like all powerful drugs from digitalis to cortisone, can indeed be dangerous unless given in carefully controlled doses, with the patient under close watch.

Medicine: Tranquil But Alert

This week the new tranquilizer goes on sale (by prescription only) throughout the U.S., with encouraging evidence that it will have the same effect on 70% or more of anxious, tense and hostile humans as it has on dingoes. Trade-named Librium by New Jersey's Roche Laboratories, it is technically methamino-diazepoxide, a synthetic chemical unrelated to previous ataractic drugs. Finding the right dose for individual patients is admittedly tricky.

Outpatient Detoxification of the Addicted or Alcoholic Patient

Several detoxification medication regimens are appropriate for use in outpatient alcohol withdrawal. Chlordiazepoxide (Librium), one of the most frequently used medications, has a well-documented efficacy profile. This drug has a wide therapeutic window and is “self-tapering” because of its long half-life. Thus, chlordiazepoxide is an ideal drug for use in outpatient detoxification. One treatment option is to “front load” the patient to provide adequate sedation (Table 3). Then small amounts of the drug are added as needed during the detoxification period.

Treatment of Alcohol Withdrawal Syndrome

Benzodiazepines are preferred and are considered first-line treatment in patients with AWS. These agents reduce the symptoms of withdrawal including seizures and help to prevent symptom progression. Long- and intermediate-acting benzodiazepines are used to treat AWS. The long-acting agents include chlordiazepoxide (14- to 100-h half-life of active metabolites) and diazepam (30-100 h). The intermediate-acting agents are lorazepam (12-h half-life), oxazepam (5-15 h), and alprazolam (6-26 h). There is no strong evidence that any one medication is superior in treating AWS. However, it is believed that long-acting benzodiazepines may provide for a smoother withdrawal effect than the intermediate.

Resources

StatPearls

Chlordiazepoxide is a long-acting benzodiazepine and is an FDA approved medication for adults with mild-moderate to severe anxiety, preoperative anxiety, and alcohol withdrawal.