Which benzodiazepine is commonly used to treat anxiety, alcohol withdrawal symptoms, and tremor?

• A. Chlordiazepoxide (Librium)
• B. Diazepam (Valium)
• C. Lorazepam (Ativan)
• D. Alprazolam (Xanax)

Answer: (A)

Long-acting benzodiazepines are especially helpful for alcohol withdrawal because their steady, extended effect smooths the sudden surge of CNS excitability and reduces risks like tremor, agitation, and seizures. Chlordiazepoxide fits this role well due to its long half-life and active metabolites, which provide ongoing suppression of withdrawal symptoms and allow for a gentler taper. At the same time, its anxiolytic properties help with the anxiety component that often accompanies withdrawal, making it a versatile option for patients who need relief from both anxiety and withdrawal-related symptoms.

Other benzodiazepines can be used in similar situations, but their profiles differ. Diazepam is also long-acting and effective for withdrawal, but chlordiazepoxide is classically emphasized for alcohol withdrawal protocols. Lorazepam is effective for anxiety and can be used in withdrawal, but its intermediate duration can be less ideal for preventing withdrawal symptoms over time. Alprazolam is potent for anxiety but is less typically used for alcohol withdrawal due to its shorter duration and higher withdrawal risk once stopped.

So, the combination of long-acting relief from withdrawal symptoms (including tremor) and anxiolysis makes chlordiazepoxide the best fit for this scenario.