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 historical trade names include Libritabs and Risolid
• TRANSMISSION ROUTE: Oral, intravenous, intramuscular

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 people 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 millions of prescriptions for benzodiazepines each year, including Librium.

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. Some early research indicated that benzodiazepines affect the metabolism of estrogen and may be associated with ovarian cancer; however, researchers failed to establish a causal link between these medications and 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.

Bibliography

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