Abstract

Chlordiazepoxide (Librium - Roche) was first marketed in 1960, five years after meprobamate. It is now more widely prescribed in the United States than any other “tranquilliser” for the treatment of common anxiety and tension states. The manufacturers recommend it for the treatment of a variety of emotional symptoms, acute and chronic alcoholism and some physical complaints arising from emotional disturbances. Diazepam (Valium - Roche) is a newer drug chemically related to chlordiazepoxide and its advertised indications are similar to those suggested for Librium. Librium is also an ingredient (with clidinium) of Libraxin (Roche) for the treatment of nervous dyspepsia, and Valium (with pentaerythritol tetranitrate) of Pentrium for the treatment of angina. Valium is said to differ “quantitatively” and “qualitatively” from Librium, than which it is reputedly five times more potent when milligram dosages are compared. However, this constitutes no advantage if the ratio of unwanted to therapeutic effects is unchanged at the lower dosage. There is in fact little evidence of any qualitative pharmacological differences, but some patients prefer Valium to Librium for the relief of their anxiety. On the other hand, many psychiatrists would agree that the attempt to remove the symptom of anxiety with any drug is in the long run bound to be “anti-therapeutic”.