Introduction to Chlordiazepoxide

Chlordiazepoxide is one of the oldest Benzodiazepines, it was the first drug of this class to be created and introduced to the market in the mid 1950's and it is still in popular use and prescription today.

It is available under several brand names due to the amount of time the drug has been on the market, some of the brands are: (Librium [most common] , Mestrual, Tropium, Libritabs and Klopoxid.

This medication is marketed as an anxiolytic and a treatment for Alcohol Withdrawal Syndrome. Daily doses can vary in range from anywhere from 5mgs to 180mgs /day.

Chlordiazepoxides potency is relatively weak in relative terms to other Benzodiazepines. It has a medium/long half life ranging in between 5 and 30 hours.

It is from this drug that Diazepam was created, Diazepam is in fact very similar in structure to Chlordiazepoxide, it is a "simpler version".

Clordiazepam itself was discovered by complete accident and was created from work a chemical dye which proved later on to have anxiolytic, sedative, hypnotic and muscle relaxant properties.

Using Chlordiazepoxide

Ways of Administration

Chlordiazepoxide is administered orally in 5mg, 10mg and 25mg capsules.
When abused some people prefer to snort benzodiazepines but this is not thought by many to be an effective means of communication as the drug is not readily soluble in water and it does not easily pass the nasal lining.

Effects of Chlordiazepoxide

Like other Benzodiazepines, Chlordiazepoxide is used both therapeutically in a medicinal context, and also abused and used recreationally. Either on it's own or as an adjunct (see below for further info on recreational use).

Chlordiazepoxide is a sedative tranquilizer (also referred to by medical staff as a minor tranquilizer along with all other benzos). As such it induces a state of relaxation and anxiolysis in anxious patients. When taken in sufficient quantities it relieves the symptoms of alcohol withdrawal - such as tremors, sweating, palpitations, insomnia, intense anxiety and panic attacks.

Combinations with Chlordiazepoxide

Chlordiazepoxide is available in the following therapeutic combinations :

Librax: Chlordiazepoxide and clidinium
Apo-chlorax: Also contains Chlordiazepoxide and clidinium
Limbitrol: Chlordiazepoxide and amitriptyline

When Chlordiazepoxide is used recreationally it is often combined with psycho-stimulants to "take the edge of the buzz" and prevent jittery tremors and palpitations which are un-desirable. It also induces a contributory effect to the euphoria when used in this was.

It is also used in a dangerous combination with Alcohol, this induces deep sedation and stupor. Unless this combination is administered responsibly it can be a life threatening endeavor. This should only be administered together with alcohol consumption if the user knows exactly what they are doing - and knows their own tolerance levels with sedative gaba-ergic substances.

Different Uses for Chlordiazepoxide

As mentioned above there are several different uses for chlordiazepoxide is used in treatment (detox) centers usually in combination with Diazepam to augment its strength and anti-convulsant efficacy to enable safe withdrawal from alcohol in patients with progressed alcoholism.

It is used recreationally and sold illegally; usually by patients who are providing inaccurate and deceitful symptoms to their doctor (such as anxiety or alcohol excess with a wish to reduce consumption) in order to obtain the drug and turn a profit on the streets.

It is sometimes prescribed to relieve the anxiety and obsessive tendencies suffered in OCD. It is usually prescribed in combination with an SSRI in this case - or another suitable anti-depressant - e.g. mirtazapine

Pharmacology of Chlordiazepoxide

Chlordiazepoxide is one of the less potent benzodiazepine; its effects however, are very similar to all drugs in that category. Chlordiazepoxide is particularly useful as a muscle-relaxant and anti-convulsant.

Chlordiazepoxide binds to the GABA(a) receptor complex on a dedicated receptor site. By doing this it potentiates GABA inhibition by increasing CI conductance and thus increasing GABA transmission.

Since GABA is the Central Nervous System's major inhibitor transmitter it plays a vital role in modulating and slowing of nerve transmission which leads to relaxation of muscles and sedation.

Chemistry of Chlordiazepoxide

Column 1	Column 2
Systematic(IUPAC) name:	7-chloro-2-methylamino-5-phenyl-3H-1,4-benzodiazepine-4-oxide
Synonyms:	7-chloro-N-methyl-5-phenyl-3H-1,4-benzodiazepin-2-amine 4-oxide, 7-chloro-2-methylamino-5-phenyl-3H-1,4-benzodiazepine 4-oxide, methaminodiazepoxide, clopoxide, Helogaphen, Libritabs, Multum, Risolid, Silibrin, Tropium; Ansiacal, A-Poxide, Balance, Benzodiapin, Cebrum, Corax, Disarim, Elenium, Equibral, Labican, Lentotran, Librium, O.C.M., Psichial, Psicoterina, Reliberen, Seren, Vita, SK-Lygen, Viansin (hydrochloride). Abboxide; Balance; Balance (pharmaceutical); CDO; Chlozepid; Control; Decacil; Eden; Helogaphen; Ifibrium; Kalmocaps; Librelease; Librinin; Menrium; Mesural; Methaminodiazepoxide; Mildmen; Napoton; Psicosan; Radepur; Viopsicol
Molecular Formula:	C16H14ClN3O, C16H14ClN3O.HCl (hydrochloride)
Molar mass:	299.75 g/mol, 336.22 g/mol (hydrochloride) [2]
CAS Registry Number:	58-25-3, 438-41-5 (hydrochloride)
Melting Point:	236-236.5 °C, 213°C (hydrochloride)
Boiling Point:	no data
Flash Point:	no data
Solubility:	Freebase sparingly soluble in chloroform, alcohol; insoluble in water. Hydrochloride soluble in water; sparingly soluble in alcohol; insoluble in hexane
Additionnal data:	pK 4.8
Notes:	Freebase aspect : light yellow plates; crystallized from ethanol. Hydrochloride crystallized from methanol

[1]

The Dangers of Chlordiazepoxide

As with all Benzodiazepines there are several dangers which need to be remembered at all times during responsible usage of Chlordiazepoxide.

First and foremost the main danger of Chlordiazepoxide is that it is a highly sedative CNS depressant which has the ability to cause a fatal overdose especially when combined with other CNS depressants.

Other drugs which when combined with Chlordiazepoxide can cause risk of death are: alcohol, opiates and opioids (morphine, oxycodone, opium), chloral hydrate, GHB and GBL.

The second greatest danger is that of tolerance and dependence due to the fact that Chlordiazepoxide is highly addictive and as a result of this should only be prescribed for a short duration, preferably in-between 2-4 weeks.

Dependence of Chlordiazepoxide is to some degree responsible for criminality in society as users addicted to this substance will be inclined to purchase these tablets illegally "on the street" if their prescrition runs out early due to abuse and possibly steal money from friends, family or even their place of business in order to have the funds to do so.

Physical Health Risks

<Physical Problem 1 - Please Identify and Add Others As Necessary>

<Physical Problem 2 - Please Identify and Add Others As Necessary>

Overdose

Reported Deaths

Mental Health Risks

<Mental Health Risk 1 - Please Identify and Add Others As Necessary>

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Side Effects

Addiction

Physical Addiction

Mental Addiction

Producing/Growing Chlordiazepoxide

Chlordiazepoxide:

Chlordiazepoxide, 7-chloro-2-methylamino-5-phenyl-3H-1,4-benzodiazepin-
4-oxide (5.1.22), is also synthesized from 2-amino-5-chlorobenzophenone. This is reacted in the usual manner with hydroxylamine, forming 2-amino-5-chlorobenzophenone oxide (5.1.20), which upon reaction with chloroacetic acid chloride in acetic acid easily cyclizes to 6-chloro-2-chloromethyl-4-phenylquinazolin-3-oxide (5.1.21). Reacting this with a primary amine, methylamine in particular, leads to an interesting rearrangement (with a ring expansion), and the reaction product turns out to be 7-chloro-2-methylamino-5-phenyl-3H-1,4-benzodiazepin-4-oxide (5.1.22)—chlordiazepoxide. An analogous rearrangement with a ring expansion also proceeds upon reaction with alkaline or alcoxides; however, it should be noted that with dialkylamines, the reaction forms the expected substitution products, 2-dialkylaminomethyl derivatives of 6-chloro-
4-phenylquinazolin-3-oxide. Chlordiazepoxide was the first representative of the benzodiazepine
series of anxiolytics to be introduced into medical practice. [1-3]



Chlordiazepoxide is used for treating neurotic conditions such as relieving feelings of fear, worry, and stress. It exhibits soporific action on the CNS, causes muscle relaxation, and possesses anticonvulsant activity.
It is frequently used after operational interventions. The most frequently used synonyms are elenium and librium.

References:

1. R.J. Horclois, Ger. Pat. 1.037.461 (1955).
2. R.J. Horclois, Fr. Pat. 1.167.627 (1959).
3. G.E. Ullyot, U.S. Pat. 2.921.069 (1960).

Forms of Chlordiazepoxide

Legal Status of Chlordiazepoxide

Chlordiazepoxide is a controlled substance 21 CFR 1308.14
Chlordiazepoxide is only permitted when a prescription from a qualified medical professional has been issued in almost all countries world-wide

United Nations

Internationally, Chlordiazepoxide is a Schedule IV "Controlled Drug"

USA

EU

Other Countries

History of Chlordiazepoxide

Because Chlordiazepoxide was the first Benzodiazepine to be synthesized and to be made available to the pharmaceutical market it was immediately apparent how unique this particular medicine was. There was much excitement and optimism with regards to the therapeutic properties of this medicine as it was considered by all intents and purposes as a relatively innocuous drug with many benefits. It was not until several years later that the incredibly addictive profile of Benzodiazepines in General was discovered and by then several thousand patients world wide were already addicted to these medicines.

It was unlike any other tranquilizer currently available (for example the barbiturates, or opiates/opioids which were some of the tranquilizers available at the time) and was described as "chemically and clinically different from any of the tranquilizers, psychic energizers or other psychotherapeutic drugs now available."

It was noted that smaller amounts were needed to reduce aggression or anxiety than that which were needed in order to induce sleep. They also discovered that the drug had anti-convulsant properties.

The arrival of Chlordiazepoxide paved the way for all other Benzodiazepines currently available today. The drugs in particular of this class which followed in relatively short order are namely:
Diazepam (in 1963) , Nitrazepam in 1965 Temazepam (in 1969) and Flurazepam (in 1973)

More Chlordiazepoxide Sections

Chlordiazepoxide

References

[1]Merck Index, fifteenth edition (2013)
[2]Calculated from Atomic Weights of the Elements, 2007