Librium remains in the system longer than many other benzodiazepines. Withdrawal from Librium may occur several days after one has stopped using the drug, and it may last for weeks.
Chlordiazepoxide
Chlordiazepoxide is the chemical name for the drug that goes by the brand name Librium.
In 1962, chlordiazepoxide was the first benzodiazepine made available to the public. It was believed to be a potential alternative to barbiturates for the treatment of anxiety and other medical uses.
At their peak, benzodiazepines were the most prescribed drugs in the world, but due to concerns regarding prescription drug abuse, prescription rates for many of these drugs have fallen off somewhat in recent years. Using Librium for the treatment of anxiety has been mainly replaced with the use of newer benzodiazepines.
Mechanism of Action
Librium acts on a specific brain receptor, the GABA-A receptor.
GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter in the brain. When it is released, it reduces the activity of other neurons in the brain. Chlordiazepoxide facilitates the release of GABA in the brain and spinal cord (the CNS).
The drug is absorbed rapidly through oral administration, and the effects are typically felt 15 to 30 minutes after taking the drug. Librium remains in the system relatively long compared to many of the later benzodiazepines; the half-life ranges between five and 30 hours.
Librium was primarily intended for the treatment of anxiety and seizures. As newer benzodiazepines have been developed, Librium has assumed a major role in withdrawal management protocols for alcohol and other benzodiazepines because of its mechanism of action.
Tolerance to Librium
Tolerance to benzodiazepines occurs at different rates in different people and to different effects of the drug.
Tolerance to the anticonvulsant or seizure-controlling effects of benzodiazepines may occur relatively quickly, as does tolerance to the sedating effects of these drugs. Tolerance to anxiety reduction may occur more slowly in many users.
Tolerance to the immediate effects of benzodiazepines, which include feelings of well-being and euphoria, often occurs very rapidly. This is why abusers of benzodiazepines begin to increase the amount of the drug they use or commonly abuse benzodiazepines like Librium with other drugs, such as other benzodiazepines, alcohol, or opiates.
Physical Dependence on Librium
Individuals who develop a physical dependence on benzodiazepines like Librium can roughly be categorized into two different groups.
The first group includes individuals who use the drug for medicinal reasons while under the supervision of a physician. These people generally do not increase the amount of the drug they use until they discuss the situation with their physician. Physicians can alter the dosage of the drug accordingly and gradually taper down the amount of the drug the person takes when it is time for the individual to stop using the drug.
The second group includes people who abuse benzodiazepines, and they are most often polysubstance abusers. They will often develop rapid tolerance to the effects they seek and increase the amount of the drug they use to get the desired effects. They will often develop significant tolerance as a result of using extremely high amounts of the drug.
Longer periods of benzodiazepine use are more likely to increase the risk of physical dependence. People in this group are more likely to continue using large amounts of the drug for extended periods of time than medicinal users.
Risk Factors for Physical Dependence
Physical dependence on benzodiazepines is more commonly observed in individuals who use or abuse short-acting and/or high potency benzodiazepines like Xanax (alprazolam) or Valium (diazepam, a relatively high-potency benzodiazepine that is longer acting). However, physical dependence can occur with any benzodiazepine, and it does occur with Librium.
In Addition to the Type of Benzodiazepine Being Used, There Other Risk Factors for the Development of Physical Dependence.
- Taking large doses of the drug for longer lengths of time
- Certain personality variables, such as low self-esteem or persistent feelings of depression
- Chronic insomnia
- Any previous history of substance abuse or other mental health disorder
- Other individual variables, such as metabolic differences, sex, or weight
Do All Users Develop Physical Dependence On Librium?
With Librium, very few individuals develop physical dependence if they only use the drug for 3 months or less.
Those who use the drug for 3 to 12 months have a 10 to 20 percent increased risk of developing physical dependence.
Those using the drug for over a year have the highest risk of developing a physical dependence on the drug. Up to 50 percent of these individuals will develop some level of physical dependence on Librium.
Withdrawal Timeline
Most often, withdrawal from Librium will begin two to three days after the person discontinues the drug. However, some individuals may not experience withdrawal symptoms for up to four days following discontinuation.
The withdrawal timeline will typically follow this course:
- Acute symptoms appear within two to three days. They will increase in intensity until they peak, which usually occurs seven to nine days after discontinuation.
- After the withdrawal symptoms reach their peak, they will slowly decrease in intensity. They will most often be abated within two to three weeks after the person has discontinued use of the drug.
- The length of the withdrawal syndrome can be quite variable. It may be as short as a week for some, or it may continue for up to six weeks in others.
- Some individuals will continue to experience psychological symptoms, including depression, problems with motivation, and cravings for Librium, for months after they discontinue the drug. This most likely does not represent a formal withdrawal process. It may represent other factors, such as changes in the structure of the brain as a result of chronic drug use or pre-existing psychological issues interacting with their drug abuse.
What are the Symptoms of Librium Withdrawal?
The symptoms of withdrawal will vary with different individuals. Some people may only experience mild discomfort; others may experience severe physical discomfort but little psychological distress; others may experience severe psychological distress but little physical distress.
Some potential withdrawal symptoms can be serious. Rebound effects — symptoms that the drug typically controls, such as anxiety, insomnia, and even seizures — may occur. When these rebound effects happen, they are typically more intense than they were originally before the person started using the drug.
Other symptoms of Librium withdrawal include:
- Increased body temperature, sweating, heart rate, and blood pressure
- Flu-like symptoms, such as headache, dizziness, nausea, vomiting, diarrhea, muscle aches and pains, muscle cramps, and similar symptoms
- Restlessness, irritability, and other feelings of general malaise
- Appetite loss
- Insomnia or other sleep problems
- Emotional symptoms, such as depression, apathy, and even psychotic symptoms in rare cases (hallucinations and/or delusional behavior)
- Seizures or spasms
- Cognitive issues, including problems with attention and memory
- Delirium tremens, a syndrome of confusion, hyperactivity or extreme lethargy, hallucinations, and disorientation
Seizures, psychosis, and delirium tremens can be potentially fatal. Severe emotional distress can lead to suicidal behaviors or the risk of overdosing during a relapse.
Management of Withdrawal Symptoms
When physicians manage withdrawal from a benzodiazepine like Librium, they accept that there will be a tradeoff of longer duration for fewer complications. They establish a longer, slower timeline of detox that results in the decreased intensity of any withdrawal symptoms compared to a quicker, more intense withdrawal period.
For this reason, individuals are typically given Librium or another long-acting benzodiazepine on a slow tapering schedule.
The initial dose of the drug will control withdrawal symptoms. Then, at specified intervals (most often once a week), the dose is very slowly decreased.
This process can last for several weeks to six months or longer, depending on the needs of the individual and their reaction to the tapering process. Because individuals withdrawing from Librium run the risk of developing serious seizures or other issues, tapering is the best approach.
Can a Person Withdraw From Librium Without Help?
There are inherent dangers to attempting Librium withdrawal without medical supervision. Overdose may occur if a person returns to Librium use during withdrawal in an attempt to make uncomfortable symptoms go away. If seizures develop, they could be fatal.
Anyone who is using Librium and wishes to discontinue their use of the drug should discuss their situation with a physician or licensed addiction medicine physician.
