Benzodiazepine Dosage Converter Based on Potencies
Benzodiazepine Dose Conversions. Comparative dosages for alprazolam, diazepam, lorazepam, oxazepam, temazepam, clonazepam, chlordiazepoxide.
Mechanism of Action - Benzodiazepines
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Mechanism of action: Binds to stereospecific benzodiazepine receptors on the postsynaptic
GABA neuron at several sites within the central nervous system,
including the limbic system, reticular formation. Enhancement of the
inhibitory effect of GABA on neuronal excitability results by increased
neuronal membrane permeability to chloride ions. This shift in chloride
ions results in hyperpolarization (a less excitable state) and
stabilization.
Hepatic disease: Depending on the agent, dosage
reductions of 50% are required in mild to moderate impairment and
most agents should be avoided in severe/acute liver disease. Refer
to the specific package insert in all cases. |
Converting From:
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(Total daily oral dose in mg)
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Converting To:
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Background info - dosing information
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Alprazolam
(Xanax ®)
Dosing (Adults): Anxiety: Immediate release: Effective doses are 0.5-4
mg/day in divided doses; the manufacturer recommends starting at
0.25-0.5 mg 3 times/day; titrate dose upward; maximum: 4 mg/day.
Anxiety associated with depression: Immediate release: Average dose
required: 2.5-3 mg/day in divided doses. Panic disorder:
Immediate release: Initial: 0.5 mg 3 times/day; dose may be increased
every 3-4 days in increments
 1 mg/day; many patients obtain relief
at 2 mg/day, as much as 10 mg/day may be required.
Pharmacokinetics:
Short-acting. Peak level: 1-2 hours. Average half-life
(variable): 12 hours (9-20 hours).
Maximum dose: 4 - 10
mg depending on indication.
Bromazepam
Dosing (Adults): Treatment
should be started with the lowest recommended dose. The maximum dose
should not be exceeded. The usual dose is 3 mg twice or three times
daily. In severe conditions up to 6 -12 mg twice or three times daily.
Treatment should be as short as possible. The patient should be
reassessed regularly and the need for continued treatment should be
evaluated, especially in case the patient is symptom free. The overall
duration of treatment generally should not be more than 8 -12 weeks,
including a tapering off process. In certain cases extension
beyond the maximum treatment period may be necessary; if so, it should
not take place without re-evaluation of the patient's status.
Pharmacokinetics:
Short-acting. Peak level: 1-4 hours. Average half-life
(variable): 20 hours (8-30 hours).
Maximum dose: 30 - 60
mg
Chlordiazepoxide (Librium ®):
Dosing (Adults): Anxiety:
Oral: 15-100 mg divided 3-4 times/day.
I.M., I.V.: Initial: 50-100 mg followed by 25-50 mg 3-4 times/day as
needed. Preoperative anxiety: I.M.: 50-100 mg prior to surgery.
Ethanol withdrawal symptoms: Oral, I.V.: 50-100 mg to
start, dose may be repeated in 2-4 hours as necessary to a maximum of
300 mg/24 hours.
Note: Up to 300 mg may be given I.M. or I.V. during a 6-hour period, but
not more than this in any 24-hour period.
Pharmacokinetics:
Long-acting. Peak level: 1-4 hours. Average half-life (variable): 100
hours
Maximum dose: ~300
mg
Clonazepam (Klonopin ®):
Dosing (Adults):
Seizure disorders:
Initial daily dose not to exceed 1.5 mg given in 3 divided doses; may
increase by 0.5-1 mg every third day until seizures are controlled or
adverse effects seen (maximum: 20 mg/day).
Usual maintenance dose: 0.05-0.2 mg/kg; do not exceed 20 mg/day.
Panic disorder: 0.25 mg twice daily; increase in
increments of 0.125-0.25 mg twice daily every 3 days; target dose: 1
mg/day (maximum: 4 mg/day)
Pharmacokinetics:
Long-acting. Peak level: 1-4 hours. Average half-life (variable): 34
hours (18-50 hours).
Maximum dose: 20
mg
Clorazepate (Tranxene ®):
Dosing (Adults):
Anxiety:
Regular release tablets (Tranxene® T-Tab®): 7.5-15 mg 2-4 times/day .
Sustained release (Tranxene®-SD): 11.25 or 22.5 mg once daily at
bedtime. Ethanol withdrawal: Initial: 30 mg, then 15 mg 2-4
times/day on first day; maximum daily dose: 90 mg; gradually decrease
dose over subsequent days.
Pharmacokinetics:
Long-acting. Peak level: 0.5 -2 hours. Average half-life (variable): 100
hours
Maximum dose: 90
mg
Diazepam (Valium ®):
Dosing (Adults):
Anxiety/sedation/skeletal muscle relaxant:
Oral: 2-10 mg 2-4 times/day
I.M., I.V.: 2-10 mg, may repeat in 3-4 hours if needed.
Sedation in the ICU patient: I.V.: 0.03 to 0.1 mg/kg
every 30 minutes to 6 hours. Status epilepticus: I.V.: 5-10 mg every 10-20 minutes,
up to 30 mg in an 8-hour period; may repeat in 2-4 hours if necessary. Rapid tranquilization of agitated patient (administer
every 30-60 minutes): Oral: 5-10 mg; average total dose for
tranquilization: 20-60 mg.
Pharmacokinetics:
Long-acting. Peak level (oral): 1-2 hours. Average half-life (variable): 100
hours
Maximum dose: ~40
mg
Flurazepam (Dalmane ®):
Dosing (Adults):
Short-term treatment of insomnia: 15-30 mg at bedtime
Elderly: Insomnia: Oral: 15 mg at
bedtime; avoid use if possible.
Pharmacokinetics:
Long-acting. Peak level: 0.5 - 1 hour. Average half-life (variable): 100
hours (40-250 hours).
Maximum dose: 60
mg
Lorazepam (Ativan ®):
Dosing (Adults):
Anxiety/sedation: 1-10 mg orally in 2-3 divided doses. Usual dose: 2-6
mg/day in divided doses. Initial dose should not exceed 2 mg in
debilitated patients. Insomnia: 2-4 mg orally at bedtime.
Operative amnesia: I.V.: Up to 0.05 mg/kg; maximum: 4 mg/dose.
Status epilepticus: 4 mg IV over 2 to 5 minutes. May repeat in 10-15
minutes.
Usual maximum dose: 8 mg.
Pharmacokinetics:
Short-acting. Onset of action:
Hypnosis: I.M.: 20-30 minutes.
Sedation: I.V.: 5-20 minutes.
Anticonvulsant: I.V.: 5 minutes, oral: 30-60 minutes. Average half-life (variable):
15
hours (8-24 hours).
Maximum dose: 10
mg (oral)
Dosing (Adults): Anxiety: 10-30 mg 3-4 times/day.
Ethanol withdrawal: 15-30 mg 3-4 times/day. Hypnotic: 15-30 mg
Pharmacokinetics:
Short-acting. Peak level: 1-4 hours. Average half-life (variable):
8
hours (3-25 hours).
Maximum dose: 120
mg
Temazepam (Restoril ®):
Dosing (Adults):
Short-term treatment of insomnia 15-30 mg at bedtime.
Pharmacokinetics:
Intermediate-acting. Peak level: 2-3 hours. Average half-life (variable):
11
hours (3-25 hours).
Maximum dose: 30
mg
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References
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Benzodiazepine Equivalence Charts:
- Arana and Rosenbaum, Handbook of Psychiatric Drug Therapy, 4th
Edition, 2000.
- Clinical Handbook of Psychotropic Drugs, 4th revised edition, Bezchlibnyk-Butler et al. editors (Clarke Insitute of Psychiatry, Toronto), Hogrefe
& Huber.
- Gelenberg AJ, Bassuk EL. The Practitioner's Guide to
Psychoactive Drugs. Springer, 1997 - 536 pages (page 234).
- Hughes W.
Clinical Pharmacy.
Macmillan Education AU, Dec 15, 2001 - 512 pages (page 167).
- Ruiz P, Strain EC. Lowinson and Ruiz's Substance Abuse:
A Comprehensive Textbook. Lippincott Williams & Wilkins, Apr
15, 2011 - 1074 pages (chapter 35: pages 503-504).
- Substance Use Disorders: A Practical Guide By Stuart Gitlow 2nd edition.
- Tyrer PJ, Silk KR. Cambridge Textbook of Effective
Treatments in Psychiatry. Cambridge University Press, Jan 24, 2008 -
920 pgs (pg 301).
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