Won't Librax (Chlordiazepoxide and Clidinium) have too strong sedating effect?

Factual Questions
1

SHORT VERSION OF MY QUESTION: Can people take Librax, especially if they drink at the same time, and not be clobbered by excessive levels of sedation/sleepiness? Is the dose for its component Librium in any way comparable, milligram for milligram, with other drugs in the same class like Klonapin?

LONG VERSION, SKIP IF YOU LIKE: Recently I was prescribed Librax after a diagnosis of IBS, and all the doctor said was that it was “for pain” and that it “might cause drowsiness.” (The dose wasn’t marked on the packet of capsules I was given, but I assume it was 5 mg of Chlordiazepoxide per capsule, as that seems to be the standard.) I was told to take it 3x/day. No reference was made to combining it with alcohol, although I truthfully reported to the prescribing doctor that I have 1-2 alcoholic beverages every day.

According to that fount of all knowledge and misinformation, the Internet:

  1. Chlordiazepoxide is a bendodiazepine.
  2. Alcohol can increase the sedative effect.

I am not unfamiliar with bendodiazepines, since I sometimes take Rivotril (aka Klonapin) in .5 milligram doses for restless legs. (I’ve never increased the dosage or frequency of administration and never will, nor have I felt ever experienced withdrawal/craving, so I’m not worried about addiction.)

Anyway, now I’m terrified to touch the Librax (which obviously I will never mix with the Rivotril). FIVE MILLIGRAMS? When a tenth that dose of Rivotril has a very noticeable sedative effect, I can’t imagine what the Librax would do. In particular, since the doctor didn’t say “and oh by the way, don’t drink if you take it” I wonder what would happen if I drank my usual 1-2 drinks before my evening dose.

I know, the best person to ask is the prescribing doctor. But I saw him on a special trip to Singapore, and while I could phone him from Jakarta, to be honest his English was so heavily imbued with a Chinese accent that I doubt I’d understand a word he said.

FINAL NOTES TO ACCOMPANY SHORT AND LONG VERSIONS: (1) You are not a medical doctor, or even if you are you are a doctor you are not MY physician, and you bear zero responsibility for anything I decide to do with the Librax, ranging from flushing it down the toilet to merrily guzzling it down with a rum-on-the-rocks as a sleep aid. (2) Thank you for all information provided - failure to say so later doesn’t mean I’m ungrateful, it means I’m avoiding bumping the thread back to the top of the list after my question gets answered.

2

This Benzodiazepine Equivalence Table says .5mg of Rivotril is equivalent to 25mg of Chlordiazepoxide (doesn’t address Librax specifically). As you can see, equivalency between benzodiazepines can vary widely.

3

People can develop tolerance for both the effects of alcohol and benzos, and some are able to ingest truckloads of both and still stay conscious. Others may experience profound sedation from combining the two. It’s generally not a good idea to be on multiple different benzodiazepines.

Equivalent dosages between benzos vary widely, as was already noted. The dosage you described is typical for librax prescriptions.

Use of benzos for treatment of IBS is generally discouraged, and not something I’d prescribe for my patients with it.

It is also recommended that IBS patients avoid alcohol.

Good luck.

4

As said above, equivalence varies widely, as does individual tolerance and metabolism. Not all medications act the same for each person.

You may not have a doctor available to you, but it is a sure bet you can reach a pharmacist - answering questions about medications is their job. If you have a regular pharmacy or mail order service you use, you can call their help line; many of the major US drugstore chains also have ‘ask a pharmacist’ services on-line. A quick search should turn one up.

5

Different drugs in a drug class will almost always have differing potencies. What we mean by potency is how much drug does it take to get the desired response, usually in a percentage of the study population (ie 50%), compared to other drugs in that same class. Clonazepam, at 0.5mg as a common dose, is approximately equivalent to 1mg of Lorazepam, and 15-20mg of temazepam, which means that at those doses, their effects will be similar. Clonazepam, in this example, would be the most potent (ie the drug requiring the lowest dosage necessary to produce it’s pharmacologic effect), while temazepam would be the least. But the key is, at their intended doses, whether you’re taking 0.5mg of one or 25mg of another, they’ll all be about the same in effect.

Why is that? It’s complex, and has to do with how much of the drug the body absorbs from the GI tract, how much (if any) the liver “clears” out before the absorbed dose reaches your circulation, how much it binds to proteins in your blood, how easily it reaches the site of action, how strongly it binds to it’s active site, and for how long it remains capable of acting in that site. Less Clonazepam is needed because one or more of the factors above weighs in it’s favor for getting to the site and acting at the site than does Chlordiazepoxide or Temazepam.

So don’t let the difference in dosage strength between the two drugs fool you. The dose you’ve been prescribed (2.5mg of Clidinium, an agent used to lessen GI muscle spasm, and 5mg of Chlordiazepoxide) is, as Qadgop has stated, perfectly appropriate for use in an IBS patient, even if it’s not the first/ideal choice for a number of reasons.

6

The dosage is appropriate for a standard-sized adult. But I must once again stress that I don’t consider it (nor does current mainstream gastro-enterology) a good practice for IBS patients to be prescribed this med.

Evaluation of Drug Treatment in IBS

7

Sorry if my choice of wording came across unclear. I didn’t mean to say that the therapy itself was the perfectly appropriate choice (clearly it’s not), merely that within the bounds of information we were given (the dose and frequency, and the assumption that this is a standard sized adult), the dosage which the OP was worrying about, was itself appropriate.