Pharmacology What might cause a profound and unintentional potentiation of librium (chlordiazepoxide)?

[Ozymandeus]

Skip to below the ##### line if its TLDR for you


I am extremely experienced with GABAergics and librium in general. I also have permatolerance to such things from decades of alcoholism, benzo, etc abuse. Not just 7 months ago I was heavily dependent and tolerant to even very potent benzos such as clobromazolam.

I am also experienced with librium, this is probably the 10th time I've been prescribed it over the last 13 odd years.

Something strange happened the other day and I nearly got a damn DUI... from librium.

Last Friday I went to the hospital for alcohol withdrawal. Not that I really needed to, my withdrawals were mild (I've been through much much worse), I went because the outpatient rehab I checked into last week told me to go.

So naturally when I got to the hospital they declined to hospitalize me because it wasn't medically necessary (I agreed and had a sigh of relief-- detoxing in a hospital sucks ass compared to an actual detox center).

Anyways they sent me home with a librium script to taper myself over the weekend at home.

They gave me 50mg that Friday afternoon then sent me home with my taper. I hardly even felt that 50mg, because librium is not a very potent benzo. In fact I have abused it in the past and have taken 300mg which didn't do much. Its not xanax...

Moving on, the next day I started my taper which was 50mg every 8 hours that day.

Here is the strange part. I took it as prescribed. I had taken 100mg by noon. My sister invited me to dinner. I accepted (but only because I am familiar with librium and it has never made me super high to the point where I cant drive), but when I got in my car I noticed I was seriously fucked up. Like not OK to drive type shit, which took me by surprise. When you realize you can't drive while completely disinhibited... thats a sign of how fucking high I was.


I was swerving and nodding while driving. I texted my sister that I was not OK to drive and parked somewhere, thinking she would come find me and we would walk the rest of the way....

Immediately after texting her I was parked I blacked out and fell asleep with the car running (I was safely parked in a parking space)

An hour later I am woken up by two police knocking on my windows. Fuck..... I am getting a DUI for sure I thought.

I thought there was no use lying, I knew that would just make the situation worse. The cops asked me if I took anything, and I was honest. Told them I just got out of detox, and I took librium, clonidine and gabapentin.

By some miracle they let me go walk home instead of arresting me. I was flabbergasted by that luck. Remember kids, never lie to cops when they are scanning you for lies like that...

I DO NOT CONDONE INTOXICATED DRIVING, MY STORY SHOULD EXPLAIN WHY.

I am honestly confused. At this point of my taper I should only have 1 pill left, but I have 5, and I am STILL fucked up. I LITERALLY SLEPT ALL DAY SUNDAY AND DIDN'T EVEN TAKE THE 100MG I WAS SUPPOSED TO TODAY BECAUSE I AM STILL FUCKED UP.

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What would cause such a profound potentiation of chlordiazepoxide?

The only other medications or drugs I have been taking are:
100ug clonidine x2 per day (tolerant, been taking for 6 months)
600mg gabapentin per day (also tolerant)
8mg suboxone per day (highly tolerant, been taking for years)
I recently stopped fakinf Acamprosate

Thats it. I don't take any supplements other than DLPA, but I doubt that would interact.

I am in rehab and not taking any drugs.

I am totally bewildered. It felt like I took a large dose of diclazepam or some shit. It was crazy. Librium is not that strong of a benzo.

Anyone care to speculate? I did injure my liver last month during my relapse, but I have had 2 blood tests since and all of my numbers are perfect.

I know librium has a complex metabolism, but its mostly CYP 3a4. I am not taking any inhibitors to my knowledge, other than racemic nicotine which I know (S) nicotine is a mild 3a4 inhibitor... I wonder if (R) nicotine is the culprit. It has interacted with other things for me such as kratom alkaloids.

To me it felt like my body was not metabolizing it, so it built up in my system to absurd amounts??? I am still very high on it and haven't taken any in over 24hr

One of the strangest drug experiences I've ever had.

 

[Ozymandeus]

It has been over 36hr since my last dose. I am still high on librium.... I've spent the 16hr or so asleep, sitting upright on my couch. Now I have a kink in my neck and my back hurts from doing so.

I'm honestly quite concerned. I don't understand how this is even possible.

My body temp is low. Which is side effect I'm used to from benzos, but not to this degree or this long.

I know librium has a half life of 36+hr, but I also know its not that powerful of a benzo. I feel like it's potency has been increased by 5x. That's what I am referring to. I feel like I've taken a completely different drug.

In my nearly 3 decades of drug use I've never had something like this happen to me. I am befuddled and almost scared to take more... I'm supposed to be taking the last pill of my taper in 2 hr but I am scared to do so and have 5 pills left

 

[DieselEstate]

It has been over 36hr since my last dose. I am still high on librium.... I've spent the 16hr or so asleep, sitting upright on my couch. Now I have a kink in my neck and my back hurts from doing so.

I'm honestly quite concerned. I don't understand how this is even possible.

My body temp is low. Which is side effect I'm used to from benzos, but not to this degree or this long.

I know librium has a half life of 36+hr, but I also know its not that powerful of a benzo. I feel like it's potency has been increased by 5x. That's what I am referring to. I feel like I've taken a completely different drug.

In my nearly 3 decades of drug use I've never had something like this happen to me. I am befuddled and almost scared to take more... I'm supposed to be taking the last pill of my taper in 2 hr but I am scared to do so and have 5 pills left

I sure as heck don't know what is responsible for your potentiation but, that was a great story to wake up to on a Monday morning. Thank You.

 

[MedicinalUser247]

Wait until your sober and then talk to your doctor about it.

 

[Jnowhere]

It has been over 36hr since my last dose. I am still high on librium.... I've spent the 16hr or so asleep, sitting upright on my couch. Now I have a kink in my neck and my back hurts from doing so.

I'm honestly quite concerned. I don't understand how this is even possible.

My body temp is low. Which is side effect I'm used to from benzos, but not to this degree or this long.

I know librium has a half life of 36+hr, but I also know its not that powerful of a benzo. I feel like it's potency has been increased by 5x. That's what I am referring to. I feel like I've taken a completely different drug.

In my nearly 3 decades of drug use I've never had something like this happen to me. I am befuddled and almost scared to take more... I'm supposed to be taking the last pill of my taper in 2 hr but I am scared to do so and have 5 pills left

I don't want to get into the specifics of my situation but I know what I am talking about in regards to legally prescribed scheduled drugs.

Over many years and countless prescriptions( all legit and needed), I have noticed something. Once in a great while I will get a script filled and it will be either weaker than it should be, or in rarer cases actually noticeably stronger.

I always get the generic version of the pills. I am careful about when I take them and almost always on an empty stomach or at least 3 to 4 hours after I have eaten for Benzos, and at least 2-3 hours after I have eaten for painkillers.

It has only rarely happened that the script was off. Usually a little too weak. But over a long period of time and countless scripts( all legit and needed,seriously) I have on a couple of occasions; ended up with pills that were actually noticeably stronger than they should have been. I am not complaining,lol

I am not sure about your situation because from your description it seemed as if the rather weak librium, should not have had that much of an effect on someone who is a hard drinker and very used to Benzos.

I think I had librium once and it was when I was hospitalized for exactly what you were there for; alcohol withdrawal.

My only reservation about saying that it was most likely too much of the librium is because, it is a rather weak drug and unlike Klonopin( clonazepam) or Ativan( lorazepam) or Xanax, librium is much more bulky. 50mg of librium is = 1 mg of Klonopin, 2mg of Ativan or 1 mg of Xanax. So 5x50mg =250mg or a 1/4 of a gram, in a pill?

I think when I had been given librium that one time it was IV, just like the morphine I was given. I was usually in really bad shape when I used to end up hospitalized a lot.

Most hospitals were I live always gave me Ativan with the morphine, except the one time I had librium and this one hospital that uses IV Dilaudid. That is 1000 times better than morphine, but wears of in under 3 hours.

If it was a pill I don't remember and I just don't see them being able to put enough Librium in a pill to cause that level of messed up as you described.

Was it it a generic? Did you recognize the pills as being Librium?
As in could you have been given the wrong pills? Was a script sent to a pharmacy and you had to pick it up?

Because I actually know a lot about alcohol abuse( in my past) and have been on various Benzos for a while.

Did it feel like a totally different drug? If so and it do they look different than other Librium pills you have had? If so, then maybe try using a pill identifier website.

If it was a generic there could have been a screw up in what was used to make the pills.

Another possibility is that the pharmacy screwed up.

Considering you have had 300mg and it didn't do much, I reluctant to say that they put too much because unless the pills are huge; it wouldn't fit. I mean 300mg is 3/10 ths of a gram. And you would have need a lot more.

I don't see the clonidine and the gabapentin doing very much to it.

Try to figure out if somehow there was a screw up at the pharmacy. Possibly a screw up at the place where the pills were made?

Or do you have any known medical conditions that could have caused this?

 

[Rectify]

Post The Structures Of The Designer Benzodiazepines You Are Taking And Post Their Structures Here For Me To Look At.

si vous plait

 

[Rectify]

Probably Cytochrome P450 Antagonism.

 

[Ozymandeus]

Wait until your sober and then talk to your doctor about it.

I kinda don't want to mention it. They will think I have some liver issue and might take away my subs and clonidine and stuff.

Plus, apart from the DUI scare, it was overall enjoyable.

Probably Cytochrome P450 Antagonism.

I think you're right and that was my pseudoeducated guess. My liver is either not metabolizing it well or is somehow taking a different preferential CYP path.

I wonder if it has any active metabolites that are more potent?

As to what is the cause, no idea. Maybe liver damage.

 

[Ozymandeus]

Over many years and countless prescriptions( all legit and needed), I have noticed something. Once in a great while I will get a script filled and it will be either weaker than it should be, or in rarer cases actually noticeably stronger.

I have also noticed this. I also have liver scarring.

Just another reason to get sober.

You know its been exactly 20 years to the day that I made my first genuine attempt at sobriety. Would be nice round number to stop on.

 

[Ozymandeus]

I am still feeling the librium and I took my last dose 72hr ago....

I think I've figured out what's causing it... but as to why, I have no idea. The medicine Acamprosate.

I may be wrong, but it seems when I take Acamprosate it potentiates it like a mofo... even the trace amounts left in my system.