Librium
Librium, the trade name for chlordiazepoxide, is a psychoactive medication primarily used to treat anxiety and insomnia. Additionally, it serves various purposes, including managing agitation, seizures, muscle spasms, and symptoms associated with alcohol withdrawal. As the first drug in the benzodiazepine class, Librium is classified as a Schedule IV controlled substance and is prescribed only by healthcare professionals. Its mechanism of action involves enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that promotes relaxation and calmness in the brain.
Despite its initial perception as safe and effective, the use of Librium has faced scrutiny since the 1970s due to reports of adverse effects, including the development of tolerance and dependence. Concerns were raised about its potential for misuse, particularly among middle-class women, leading to investigations by the U.S. Congress. The medication is now recommended for short-term use only, and while the brand name Librium is no longer available, chlordiazepoxide continues to be prescribed generically. Users may experience a range of side effects, including paradoxical reactions, withdrawal symptoms, and long-term health risks, particularly in older individuals. Awareness of these potential risks is crucial for anyone considering or currently using Librium.
Subject Terms
Librium
DEFINITION: Librium, trade name for chlordiazepoxide, is a psychoactive drug used to treat anxiety and insomnia. It is also used for agitation, seizures, muscle spasms, alcohol withdrawal, and as a premedication for certain medical and dental procedures. Librium was the first in the class of benzodiazepines, the minor tranquilizers.
STATUS: Available by prescription only
CLASSIFICATION: Schedule IV controlled substance
SOURCE: A chemical structure formed by the fusion of a benzene ring and a diazepine ring; other trade names include Libritabs, Novapam, Risolid, Silibrin, Tropium, and Zetran
TRANSMISSION ROUTE: Ingestion, intravenous, intramuscular, rectal
History of Use
Librium works by acting on gamma-aminobutyric acid (GABA), a chemical that occurs naturally in the brain. Brain cells affected by GABA slow down and stop firing, calming the muscles and heart rate and alleviating anxiety and insomnia. When first prescribed, Librium and other benzodiazepines were considered safe and effective. By the 1970s, there were reports of adverse physical and psychological effects. Some persons developed a tolerance to and even a physical dependence on the drug. The United States (US) Congress investigated benzodiazepines, unusual for a drug legally prescribed. The majority of people taking the drug were middle-class women.
The women’s health movement of the 1970s argued that Librium was an agent of social control, a drug that tranquilized women into submission. Addiction specialists considered Librium to be prone to misuse. Emergency rooms often found Librium and other benzodiazepines in persons who overdosed. From a peak of more than 120 million prescriptions per year in the mid-1970s, Librium fell to 60 million prescriptions by 1979. The US Food and Drug Administration now limits Librium to short-term use. Doctors in the US continue to write over 50 million prescriptions for benzodiazepines each year, and Librium is included in these numbers. However, Librium is no longer available under the brand name and is only available as a generic form of chlordiazepoxide. Still, many continue to use the name Librium in reference to the drug.
Effects and Potential Risks
Persons taking Librium sometimes experience paradoxical reactions such as seizures, aggression, impulsivity, irritability, or suicidal behavior. Long-term Librium use risks deterioration of physical and mental health. Sudden withdrawal from Librium can cause severe pain in the muscles and joints, insomnia, or suicidal thoughts. A person may experience extrapyramidal symptoms, such as restlessness, involuntary movements, or uncontrollable speech.
Librium may cross the placenta with other substances, putting a fetus at risk for withdrawal, extrapyramidal symptoms, or perinatal complications. Benzodiazepines affect the metabolism of estrogen and may have an association with ovarian cancer.
Benzodiazepines pose the greatest risk to older people, causing memory problems, daytime sleepiness, impaired motor coordination, and increased risks of car accidents and falls. Long-term effects may include depression, dementia, and acute anxiety.
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