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Librax: What is it and What are the Side Effects?

The most common gastrointestinal disorder you’ve never heard of is irritable bowel syndrome, or IBS. IBS is a common, chronic gastrointestinal condition that is estimated to affect between 10 and 15 percent of the adult population in the United States, yet only about 5 to 7 percent of adults have actually been diagnosed. The jury is still out on exactly what causes IBS, but it is about twice as likely to affect women as men. The condition can cause abdominal pain and discomfort associated with altered bowel habits that can make the condition unpleasant and embarrassing. Medications like Librax can help patients experiencing symptoms of IBS, but what is Librax and what are the side effects?

What is Librax?

Librax is a prescription medication that is made from a combination of two drugs: clidinium bromide and chlordiazepoxide hydrochloride. Clidinium belongs to a class of drugs called anticholinergics/antispasmodics, while chlordiazepoxide belongs to a class of drugs known as benzodiazepines, which are central nervous system depressants. Librax was first approved by the U.S. Food and Drug Administration (FDA) in 1966 for the treatment of gastrointestinal disorders such as stomach ulcers, irritable bowel syndrome, and other conditions. Clidinium works by reducing stomach acid and decreasing intestinal spasms that are often associated with irritable bowel syndrome, and it also helps to slow down the natural movements of the gut and relax the muscles of the intestines and stomach. Chlordiazepoxide works on chemicals in the brain to produce a calming effect and reduce anxiety.

Librax should be stored at room temperature out of the reach of children.

What is Librax Used to Treat?

Librax is used to treat a number of gastrointestinal disorders, including stomach ulcers, irritable bowel syndromes, acute enterocolitis, treatment of peptic ulcers, and some bowel infections, when used in conjunction with other medications.

Stomach Ulcers

Stomach ulcers, often called gastric ulcers, are open sores that develop on the stomach lining. There are a number of different factors that can cause or contribute to gastric ulcers, including an infection with a type of bacteria called H. pylori and prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen sodium or ibuprofen. Spicy or highly acidic foods do not cause stomach ulcers, although they can exacerbate them, and stress can also make gastric ulcers worse. Common symptoms of stomach ulcers include burning pain in the stomach, a feeling of fullness, belching, or bloating, heartburn, intolerance of fatty foods, and nausea. When ulcers are severe, they can cause people to vomit or vomit blood, and blood may also be present in the stools. 

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition that impacts the large intestine. IBS consists of a group of symptoms that typically occur at the same time, and people can be more likely to experience IBS with constipation or with diarrhea. In order to be diagnosed with IBS, patients typically must experience symptoms a minimum of at least three days per month for at least three months. Symptoms associated with IBS include:

  • Cramping
  • Abdominal pain
  • Bloating and gas
  • Constipation
  • Diarrhea

In addition to experiencing IBS with constipation or IBS with diarrhea, some people experience both symptoms at different times. IBS is more likely to affect women than men, and scientists do not entirely understand what causes the condition.  

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How Much Does Librax Cost?

Librax can be purchased in both the brand name form and in a generic version of the drug, known as chlordiazepoxide/clidinium. As is the case with the majority of medications, the brand name version of the drug is significantly more expensive than the generic version of the medication. Purchasing 30 capsules of Librax will cost approximately 1,400 dollars, while purchasing a one-month supply of the generic version of the medication will cost about 58 dollars. Many, but not all, forms of commercial insurance offer coverage for generic Librax, but patients can also use a pharmacy discount card to  receive substantial savings on the medication. Pharmacy discount cards offer discounts on all FDA-approved medications, whether brand name or generic, regardless of a person’s insured status.

As noted above, the brand name version of Librax is prohibitively expensive for many patients, especially when compared to the generic cost of the medication. Still, some patients are uncomfortable using generic drugs because they are concerned that they do not meet the same quality and safety standards of brand name medications.  However, the FDA subjects generic drugs to the same stringent quality and safety testing as brand name medications, so patients can rest assured that the generic drugs are safe and effective. Generic drugs differ from brand name medications only in their inactive ingredients, which affect cosmetic qualities like color, size, shape, and taste but do not affect how the medication works. 

What Dose of Librax Should I Take?

Librax capsules are available in a strength of 5 mg of chlordiazepoxide and 2.5 mg of clidinium. The medication is typically taken by mouth and may be taken up to three to four times per day depending on a patient’s needs. When taken for a gastric ulcer or IBS, most adults will take one or two capsules between three and four times per day, typically about 30 to 60 minutes before meals. Older adults may need to take a reduced dose of the medication, such as two capsules per day, in order to avoid side effects. 

What are the Side Effects of Librax?

Some side effects of Librax are common and generally do not require medical attention, while others can be serious and should receive medical attention immediately. Common side effects of Librax that do not usually require medical attention include:

  • Dry mouth
  • Constipation
  • Urination problems
  • Rash
  • Irregular menstrual periods
  • Blurred vision
  • Nausea
  • Drowsiness
  • Swelling
  • Increased or decreased interest in sex
  • Reduced mental alertness

Other side effects of Librax are serious and require immediate medical attention. Side effects requiring immediate medical attention include:

  • Severe drowsiness
  • Breathing problems 
  • Problems with balance or coordination
  • Confusion
  • Anger
  • Signs of liver problems
  • Severe constipation
  • Restless muscle movements in your eyes, jaw, tongue, or neck
  • Jaundice (yellowing of the skin or eyes)
  • Light-headed feeling, like you might pass out
  • Unusual excitement
  • Feeling restless
  • Painful or difficult urination
  • Fever or sore throat
  • Allergic reaction to Librax, as indicated by:
    • Hives
    • Swelling of the face, tongue, lips, or throat
    • Difficulty breathing

Are There Any Risks Associated With Librax?

Librax has a black box warning from the FDA regarding the concomitant use of benzodiazepines and opioids. Using chlordiazepoxide, a benzodiazepine contained in Librax, in conjunction with opioid medications, such as Vicodin, can cause profound sedative effects, respiratory depression, coma, and death. In order to avoid these potentially serious side effects, patients who have other treatment options besides opioid medications should not be prescribed opioids while taking Librax. When the medications must be taken concurrently, the dosages and durations of use of each medication should be limited, and patients should be closely monitored. Additionally, withdrawal symptoms are highly likely. 

In addition to the black box warning from the FDA regarding concomitant use of benzodiazepines and opioids, Librax is also associated with an increased risk of suicidal thoughts and behavior, particularly in patients who are suffering from depression and other mental health medical conditions. Patients should be aware of signs of emerging or worsening depression, as well as any unusual changes in mood or behavior, and should pay particular attention to the presence of suicidal thoughts, behaviors, and thoughts about self harm.

Librax can also cause drowsiness or dizziness and reduced alertness, particularly in older adults. People should not drive a car or operate dangerous machinery while taking Librax until they know how the medication affects them. People should also avoid the use of alcohol or other drugs with a sedative effect while taking Librax.

Is it Possible to Overdose on Librax?

It is possible to overdose on Librax, so patients should exercise caution when using the medication and should never take more than the amount prescribed by their doctor. If an individual is experiencing any of the following signs of a Librax overdose, seek emergency medical help right away:

  • Blurred vision
  • Difficulty having a bowel movement (constipation)
  • Lack of coordination
  • Sleepiness or unusual drowsiness
  • Change in consciousness
  • Dry mouth
  • Loss of consciousness

Who Should Not Take Librax?

Librax can be a helpful medication for some people, but it is not right for everyone, especially with the potential for drug abuse. Librax is usually not taken for medical emergencies, and it should be avoided by people with any of the following conditions:

  • Glaucoma
  • Bladder obstruction
  • High blood pressure
  • Enlarged prostate
  • Problems with urination
  • Allergies to chlordiazepoxide or clidinium
  • Pregnancy or breastfeeding, as it can pass to the unborn baby and breast milk
  • Possible drug interactions include antihistamines, barbiturates, MAOIs, diazepam, 

Other people may be able to use Librax safely but should use caution and give their doctor a complete medical history prior to taking the drug. Make sure to tell your doctor if you have:

  • Liver disease
  • Kidney disease
  • A history of suicidal thoughts or behavior
  • A history of depression
  • A history of drug or alcohol addiction, or drug or alcohol abuse
  • A current prescription for opioids
  • Currently using mental health prescription drugs such as SSRIs, tricyclic antidepressants, or MAO inhibitors/phenothiazines
  • A history of using illegal narcotics/opioids

Sources:

https://www.webmd.com/drugs/2/drug-15881/librax-with-clidinium-oral/details 

https://www.drugs.com/librax.html 

https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f99ebf66-f207-4a97-9666-4da1d72b061c 

https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223 

https://www.healthline.com/health/irritable-bowel-syndrome 

https://gi.org/topics/irritable-bowel-syndrome/

Published October 1st, 2020 by Bridget Reed

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