Benzodiazepine Equivalencies
Information in the table below is taken from the Ashton "Benzodiazepine Equivalency Table" which is based on the extensive research and clinical experience of Professor C Heather Ashton.
Why Switch To Diazepam to taper?
The Ashton Protocol recommends switching short half life benzos over to diazepam because:
it is one of the most slowly eliminated benzodiazepines with a half-life of up to 200 hours. This longer half life is a clear advantage for those who are tapering as the blood level for each dose falls by only one half in about 8.3 days
tapering from diazepam can give a smoother and more gradual fall in blood level, allowing your body to adjust slowly to a decreasing concentration of the benzodiazepine
with short half-life benzos e.g. lorazepam (half life 10-20 hours) the levels of medication in the blood drop much more quickly and withdrawal symptoms can occur between doses, because your body has little time to adjust to lowering concentrations. This is called inter-dose withdrawal
it comes in readily available small dosage strengths making it easier to taper from. Some of the more potent benzos are very challenging to reduce from, especially if dry cutting.
When making the switch it is important to do it gradually.
The table below provides the approximate equivalent doses of 10mg valium/diazepam for each of the medications listed.
For example, straight from the table:
0.5mg of xanax is the same equivalency as 10mg of diazepam
1mg of ativan is the same equivalency as 10mg of diazepam
20mg of temazepam is the same equivalency as 10mg diazepam
All of the drugs listed above are for SHORT TERM use only (2-4 weeks maximum).
Half life is the time taken for blood concentration to fall to half its peak value after a single dose. The half-life of active metabolite is shown in square brackets. This time may vary considerably between individuals.
These equivalents do not agree with those used by some authors. They are firmly based on clinical experience during switch-over to diazepam at start of withdrawal programs but may vary between individuals.
In the UK clobazam (Frisium) and clonazepam (Rivotril) are licensed for use as anti-epileptics only.
Non benzodiazepines with similar effects are included in the table. They are chemically different from benzodiazepines but have the same effects on the body and act by the same mechanisms.
More info can be found in the Ashton Manual about why a diazepam taper might be advisable.