Ativan (lorazepam) vs. Librium (chlordiazepoxide)

• Ativan (lorazepam) and Librium (chlordiazepoxide) are benzodiazepines used to manage anxiety disorders, before anesthesia for sedation, and to prevent and treat alcohol withdrawal.
• Ativan is also used for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, and for treating seizures (status epilepticus).
• Side effects of Ativan and Librium that are similar include drowsiness and dizziness.
• Side effects of Ativan that are different from Librium include weakness, unsteadiness, depression, amnesia, loss of orientation, headaches, sleep disturbances, low blood pressure (hypotension), impotence (erectile dysfunction, or ED), changes in appetite, and sleep apnea.
• Side effects of Librium that are different from Ativan include impaired muscle control, confusion, skin problems, fluid retention (edema), menstrual irregularities, nausea, constipation, movement disorders, and decreased sex drive.
• Withdrawal symptoms such as agitation, insomnia, seizures, tremors, muscle cramping, vomiting, and sweating may occur if you suddenly stop taking Ativan.

Ativan (lorazepam) is a benzodiazepine, a drug class that also includes diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and flurazepam (Dalmane). Ativan is used to manage anxiety disorders, for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, and for treating seizures (status epilepticus). Ativan also is administered before anesthesia for sedation and used for prevention and treatment of alcohol withdrawal. Research shows that excessive nerve activity in the brain may cause anxiety and other psychological disorders. Research also shows that Ativan and other benzodiazepines may act by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter, in the brain to reduce activity.

Librium (chlordiazepoxide) is a long-acting benzodiazepine used to manage anxiety disorders, and provide short-term relief of anxiety symptoms, withdrawal of acute alcoholism, and for preoperative apprehension and anxiety. Librium has anti-anxiety, sedative, appetite-stimulating, and weak pain relieving properties. Research shows that Librium may enhance or increase the activity of GABA, a neurotransmitter, a chemical that cells in the brain use to suppress the activity of other cells.

Ativan

WARNING:

• Like all benzodiazepines, Ativan can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If Ativan is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and sweating.

The most common side effects associated with Ativan are:

• Sedation
• Dizziness
• Weakness
• Unsteadiness

Other side effects include:

• A feeling of depression
• Amnesia
• Loss of orientation
• Headaches
• Sleep disturbances
• Low blood pressure (hypotension)
• Impotence (erectile dysfunction, ED)
• Changes in appetite
• Sleep apnea

Possible serious side effects include:

• Extrapyramidal symptoms
• Respiratory depression
• Suicidal ideation/attempt
• Seizures
• Depression

Librium

Reported side effects include:

• Drowsiness
• Impaired muscle control (ataxia)
• Confusion
• Dizziness
• Skin problems
• Edema
• Minor menstrual irregularities
• Nausea
• Constipation
• Movement disorders
• Decreased desire for sexual activity (decreased libido)

Serious side effects that have been reported are:

• Blood disorders
• Jaundice
• Liver dysfunction

Ativan

• The dose of Ativan is tailored to the patient's needs.
• The usual dose for treating anxiety is 2 to 6 mg orally every 8 to 12 hours as needed.
• Insomnia is treated with 2 to 4 mg given at bedtime.

Librium

Adults

• For the treatment of mild to moderate anxiety disorders or symptoms: 5 to 10 mg by mouth 3 to 4 times daily.
• For the treatment of severe anxiety disorders or symptoms: 20 to 25 mg by mouth 3 to 4 times daily.
• For the management of preoperative apprehension and anxiety: 5 to 10 mg by mouth 3 to 4 times daily on days preceding surgery.

Pediatrics

• For the treatment of anxiety symptoms in children age 6 years to adolescents: the usual daily recommended dose is 5 mg 2 to 4 times daily.
• Dosage may be increased to 10 mg per day given in 2 to 3 divided doses if necessary.
• Librium is not recommended for use in children below the age of 6 years.

Geriatric patients

• The usual recommended dose is 5 mg 2 to 4 times daily.

Ativan

• Ativan and all benzodiazepines accentuate the effects of other drugs that slow the brain's processes such as alcohol, barbiturates, narcotics, and tranquilizers, and the combination of Ativan and these drugs may lead to excessive sedation. There have been cases of marked sedation when Ativan was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction, but use caution if Ativan and loxapine are used together.

Librium

Librium is metabolized or broken down by a group of enzymes in the liver known as the cytochrome P450 3A4 enzymes. Drugs that inhibit these enzymes reduce the metabolism of Librium and have the potential for causing side effects.

Examples of CYP3A4 inhibitors are:

• amiodarone (Cordarone)
• Anti-retroviral protease inhibitors (some types of anti-HIV medications)
• fluconazole (Diflucan)
• itraconazole (Sporanox)
• ketoconazole (Nizoral)
• voriconazole (Vfend)
• miconazole (Monistat)
• cimetidine (Tagamet)
• clarithromycin (Biaxin)

Additionally, inducers of the CYP3A4 enzymes may increase the activity of these enzymes and cause blood levels of Librium to decrease.

Examples of CYP3A4 inducers are:

• carbamazepine (Tegretol)
• rifampin (Rimactane)
• phenytoin (Dilantin)
• St. John's Wort

Librium has depressant effects on the central nervous system. Medications which have similar activity may increase the risk for drowsiness, respiratory depression, and other CNS depressant effects. Therefore, avoid using Librium with alcohol, kava-kava, other benzodiazepines, and opiates.

Ativan

• Ativan and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Ativan is best avoided if at all possible in the first trimester and probably throughout pregnancy.
• Ativan is excreted in human milk and should be avoided during pregnancy.

Librium

• Librium is classified as FDA pregnancy risk category D. Due to the risk of potential harm to the fetus, use of Librium during pregnancy is not recommended.
• This medication is thought to be excreted into breast milk. Due to the lack of conclusive safety data, use in nursing mothers is not recommended.