Benzodiazepine Equivalence

Intermediate Acting: 

 

Alprazolam (Xanax) 0.5 mg OP
  • Peak: 1-2 hrs
  • Half-life: 6-12hrs
  • Use: anxiolytic
Lorazepam (Ativan) 1 mg PO
  • Peak: 2 hrs
  • Half-life: 12 hrs
  • Use: anxiolytic, anticonvulsant, hypnotic
Clonazepam (Klonopin) 0.5 mg PO
  • Peak: 1-4 hrs
  • Half-life: 30-40 hrs
  • Use: anxiolytic, anticonvulsant
Temazepam (Restoril) 10 mg PO
  • Peak: 1-2 hrs
  • Half-life: 8-10 hrs
  • Use: anxiolytic, hypnotic

Long Acting:

 

Diazepam (valium) 5 mg PO
  • Peak: 1-1.5 hrs
  • Half-life: 48-100 hrs (active metabolite up to 200 hrs)
  • Use: anxiolytic, muscle relaxant, anticonvulsant
Chlordiazepoxide (Librium) 25 mg PO
  • Peak: 2- 4 hrs
  • Half-life: 24-48 hrs.  (active metabolite up to 200 hrs)
  • Use: anxiolytic, alcohol withdrawal

Notes:
  • Hypnotics are used to induce sleep
  • There is considerable variability in the reported ranges for peak concentration and half-life. Wherever possible, data is extracted from package inserts.
  • Long acting benzodiazepines have active metabolites.
  • Dosing listed above is for equivalence in ORAL administration only.
  • Careful consideration should be given to patient age, liver function, and co-ingestion of metabolic inhibitors or other non-benzodiazepine sedative medications (opioids, alcohol, etc).

References:
  1. Benzodiazepines: How They Work And How To Withdraw (aka The Ashton Manual), Chapter : The Benzodiazepines, What They Do In The Body;  Online Manual
  2. DailyMed, Official Provider Of FDA Label Information; Website
  3. Medscape Benzodiazepine Equivalence Table; July 2018; Table
  4. Management Of Benzodiazepine Withdrawal; Government Of South Australia; SA Health; WS2.4 Handout

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