An anti-anxiety medication also used to relieve agitation during alcohol withdrawal, Librium is a brand name formulation of the long-acting benzodiazepine medication chlordiazepoxide, the National Library of Medicine (NLM) publishes. Benzodiazepines are a class of prescription medications that act as sedatives, increasing levels of gamma-aminobutyric acid (GABA) in the brain and reducing the stress response, and with it certain functions of the central nervous system, like body temperature, respiration levels, blood pressure, and heart rate.
These drugs are habit-forming, as regular use can cause the brain to become dependent on them. Brain chemistry will then be disrupted, and if the drug is stopped suddenly, the body will try to compensate and dangerous withdrawal side effects may occur. Detox refers to the period of time it takes for Librium to be processed out of the body. Because the withdrawal syndrome for benzodiazepines can be significant, medical detox is considered the safest method for withdrawal.
Detox from Librium
Withdrawal symptoms for a drug will begin as soon as the drug wears off or stops working in the system. Librium has a long half-life of between five and 30 hours, meaning that it stays active in the body for a day or two, and withdrawal likely starts around 24-48 hours after the last dose of the drug.
The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that the bulk of the withdrawal symptoms, often referred to as acute withdrawal, generally last between a week and a month for benzodiazepine drugs. The general timeline for detox, with common withdrawal side effects, is outlined below.
Days 1-2 after stopping Librium:
- Rebound anxiety
Days 2-7 after the last dose of Librium:
- Muscle tension and aches
- Abdominal cramps and nausea
- Depression and difficulties feeling pleasure
- Mood swings
- Irregular heart rate
- High blood pressure
Weeks 2-4 after stopping Librium:
- Dysphoria, or trouble feeling pleasure
- Trouble concentrating
- Depressed mood and potentially suicidal thoughts
Beyond one month:
- Symptoms may wax and wane and begin to diminish over time.
- Depression, anxiety, and insomnia may require specialized treatment to manage fully.
Over a quarter of all emergency department (ED) visits related to the misuse of pharmaceutical drugs in 2011 involved benzodiazepines, the Drug Abuse Warning Network (DAWN) reports. Librium withdrawal is unpredictable, and individuals who have been using (or abusing) the drug for a long time and in high doses are often significantly dependent on it, making the withdrawal syndrome more intense and even potentially dangerous.
When the brain is used to having functions of the central nervous system dampened, and the drugs that have been suppressing heart rate, blood pressure, respiration, body temperature, and feelings of anxiety are suddenly not there anymore, a rebound can occur. The brain may then try to regain balance too quickly, leading to seizures, severe anxiety, and irregular blood pressure, heart rate, and breathing rate. This can be potentially dangerous and possibly even life-threatening.
Detox Is Different for Everyone
Over 8 percent of the American adult population suffered from a substance use disorder in 2014, according to the National Survey on Drug Use and Health (NSDUH). While millions battle drug dependence, no two people will experience withdrawal in exactly the same way. Detox timelines are a general guideline and can vary from person to person. Some people have more intense withdrawal symptoms than others or suffer from side effects for longer.
There are some specific indicators that may help to determine how significant Librium withdrawal may be, however. For instance, the amount of Librium taken, the method of intake, and how long the drug was taken can be factors in withdrawal. The more severe the drug dependence, the more intense and longer withdrawal is likely to be. Someone who alters Librium (e.g., crushes it to then snort, smoke, or inject the drug) may create dependence more rapidly than someone who swallows the drug, for instance. Polydrug abuse, or the use of other drugs and/or alcohol with Librium, can also complicate withdrawal and lead to more side effects.
SAMHSA reports that close to 8 million adults in the United States battle co-occurring disorders – that is they suffer from both a mental health disorder and addiction to drugs and/or alcohol at the same time. Librium is often prescribed to treat anxiety, and individuals may misuse the drug as a way of coping with underlying psychological issues. Co-occurring mental and medical concerns can influence the withdrawal timeline and potentially make some of the side effects more pronounced. Anxiety and depression may be more severe, for instance, in someone suffering from a mood or anxiety disorder and also undergoing Librium detox, thus requiring professional help to ensure that suicidal ideations are not carried out.
Genetic and biological factors also play a role in Librium detox and withdrawal, and they are, of course, individual to each person. Each person’s metabolism is different, for example, which can impact how quickly the drug is processed out of the body. High-stress environments may also compound Librium withdrawal, and extend and prolong the severity of the cravings and symptoms, making it more likely a person will relapse.
Medical Detox Eases Withdrawal
Medical detox can manage the bulk of the withdrawal symptoms and aid in promoting a physical level of stabilization that can prepare an individual for treatment and recovery. Medical detox provides the highest level of care during withdrawal. A medical detox program will have a person stay in a specialized facility for about 5-7 days on average and then send them on to an addiction treatment program. During medical detox, medical and mental health professionals can monitor a person’s vital signs and psychological health to ensure that they remain healthy and safe.
Medications can also be helpful in stabilizing functions of the central nervous system during detox, keeping heart rate and blood pressure within normal limits. Mood-stabilizing drugs and sleep aids may be useful during detox for some of the emotional side effects of withdrawal. Medical detox can help to manage withdrawal symptoms and therefore aid in shortening the duration and severity of acute withdrawal.
Detox is generally considered to be merely a part of a more complete treatment plan. Withdrawal symptoms, like cravings, sleep disturbances, and mood fluctuations, may continue to present themselves for several weeks to months following the initial detox program; therefore, continuing and ongoing treatment, including both pharmaceutical and therapeutic methods, is highly beneficial for long-term recovery.
The Tapering Process
Librium is not recommended to be stopped “cold turkey” since the resulting rebound may be dangerous and even life-threatening. Like other benzodiazepines, Librium is generally tapered off slowly during detox. The US Department of Veterans Affairs (VA) recommends the following:
- Reduce the dosage of benzodiazepines 10-15 percent initially and then watch for withdrawal symptoms.
- Look to reduce dosage 50 percent in the first 2-4 weeks, about 25 percent every other week.
- Keep reducing dosage 25 percent in each subsequent two-week period.
- Reduce dosage until it is down to zero.
Since Librium is a long-acting benzodiazepine, it is often used during the weaning or tapering process itself. Individuals are often switched off other shorter-acting benzodiazepines, and even alcohol, to a drug like Librium during detox. A Librium taper should be accompanied by behavioral therapies to effectively treat substance abuse and addiction issues.