Batman #677: A Medical Review
Batman #677 “Batman R.I.P.: Batman in the Underworld”
Grant Morrison, writer
Tony Daniel, penciler
Arch-villain Doctor Hurt is explaining his plan to his villainous colleagues:
Librium (generic name: chlordiazepoxide) is a drug in the benzodiazepine class — in other words, it’s from the same class of medication as Valium, Xanax, and Halcion. Like all drugs in this class, it acts as a relaxant, a sedative, and an anti-anxiety medication. Librium is a fairly old drug and is not in common use today.
I find Librium to be an interesting choice of drug for Doctor Hurt to use. As previously mentioned, it is a fairly old drug (in this case, “old” means about fifty years) and it was the first benzodiazepine discovered. Librium is not nearly as potent as later benzodiazepines, and it requires a dose that is roughly 20-50 times higher. This is going to make a big difference when dosing someone by sword cut — an unreliable method at best. It’s got to be a lot easier to get 0.5 MG of Xanax into a wound compared to 25 MG of Librium.
Librium has a very long half life, with some of its metabolites taking over a week to be broken down by the body. This can make it dangerous to use as a daily medication because these metabolites build up quickly. However, Librium’s long effect after a single dose may be just what the doctor is looking for in this situation.
Benzodiazepines are primarily used as relaxants and anti-anxiety agents in anxious patients, and sleep aids in insomniacs. They can also be used as muscle relaxants, to stop seizures, and to ease alcohol withdrawal. I know of no benefit to hypnosis or trigger phase induction offered by these medications, by I’m willing to explain this aspect away as “comic book science.” Of note, all benzodiazepines are habit forming and can become addictive so I tend to prescribe them with caution. Librium isn’t used that much anymore, having been supplanted by newer and safer medications.
So why did Doctor Hurt choose Librium? Why not use a more modern medication that doesn’t require such a hefty dose?
Is it the benzodiazepine he is most familiar with? Or maybe the only one he is familiar with?Librium was developed in the late 1950s, coincidentally (I’m sure) the same time Batman #113 (featuring “Batman: The Superman of Planet-X“) was published – a story which seems to be playing a large role in the Batman R.I.P. storyline (for instance, it introduced the planet Zurr-En-Arrh and the Bat-Radia). Diazepam (Valium), the second benzodiazepine, didn’t emerge until 1963.
Does the long half-life of Librium offer some advantage to his plan?Or I may be reading too much into a throwaway line — it certainly wouldn’t be the first time — but Librium seems such a odd choice, and to refer to it by brand name, that it caught my eye.
August 6th, 2008 at 6:53 am
I’ll admit that I’m mainly familiar with Librium because originally that was what they were going to name the emotion-removing drug in Equilibrium (upon finding that the word Librium was trademarked, they chose the more recognizable but non-infringing name of Prozium for the drug). Until now, I hadn’t actually realized that Prozac and Librium were the same kind of drugs. It adds an additional layer to the name switch.
August 6th, 2008 at 8:54 am
In psychiatry and addiction medicine, Librium is also sometimes used for alcohol or benzodiazepine detoxification as a more or less “self-tapering” benzo to use in withdrawal, again, because of its long half life. You still generally taper it to detox the patient but it has a long tail before the drug is gone from the system completely. Because it is metabolized by the liver, it is not as good a choice as, say, oxazepam or lorazepam if there is any liver impairment, as there frequently is in chronic alcoholics.
I doubt anyone would start a patient Librium these days as an anxiolytic.
None of this explains why it would be useful in this comic - I agree it’s an odd choice; either they want the long half life or the writer just picked a med that is modestly plausible in its mechanism of action but isn’t as famous among the lay public as Xanax is, either as an anxiolytic or as a drug of abuse, since that’s not how they’re using it here and so confusion is avoided. A short-acting substitute that could have been chosen would be Lexotan (bromazepam), which isn’t available in the US so isn’t well known among the public. Of course, since it isn’t sold in the US it would be harder for Dr. Hurt to get a hold of in Gotham.
August 6th, 2008 at 10:48 am
Official Comment
In the past five years, I think I’ve prescribed Librium twice. Once was for alcohol withdrawal, just like you mention. It does work well for it, but you have to be careful not to substitute one addiction for another. The second was for a patient who has been on it for 20+ years for anxiety. She only takes one pill every few weeks and it seems to work well for her, so I decided that changing medications was probably not in her best interest (following the old adage “if it ain’t broke, don’t fix it”).
August 7th, 2008 at 1:58 pm
I vote for the Equilibrium reference, myself.
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