Switching to diazepam | Right Decisions

Diazepam is a longer acting B-Z. If alternative benzodiazepines are being taken, converting to the equivalent diazepam dose allows for smaller dose reductions steps, due to the range of licensed preparations available. Diazepam’s longer acting effects are less likely to be associated with withdrawal effects; especially for people receiving short acting B-Z and/or experiencing high levels of dependency.^68,69,86 Therefore this is the preferred method for gradual reduction.

Some individuals however may want to reduce by continuing their current B-Z. While this may be possible with nitrazepam and temazepam, due to a range of licensed preparations being available, it may be more challenging with other B-Z due to the range of tablet doses available. As a result the size of the dose reduction steps may be large - increasing the potential risk of withdrawal effects. Where individuals decide to reduce using their current B-Z, the risk-benefits should be discussed and closer follow up may be required.

Approximate dose equivalents and switching considerations

Due to individual variability and differing half-lives (see the table below) this means that these are approximate dose equivalents, not exact equivalence.
Variability between individuals may be due to a range of effects e.g. liver impairment reducing/slowing drug excretion, which can increase B-Z half-lives and increase the risk of accumulation and drug effects.
Dose equivalents can never be exact and should be interpreted considering your clinical knowledge and the individual's needs. Older adults and frail people may experience next day sedation due to the long half-life of diazepam.
Drug interactions and drug-disease interactions should be considered.
Dose equivalents vary between authors, they are based on clinical experience but may vary between individuals.

Approximate equivalent doses

Drug	Approximate equivalent dose	Half-life (hours, active metabolite)
Diazepam	5mg	20-100 (36-200)
Chlordiazepoxide	12.5mg	5-30 (36-200)
Clobazam*	10mg	12-60
Clonazepam*	0.25mg (250mcg)	18-50
Loprazolam	0.5mg (500mcg) -1mg	6-12
Lorazepam	0.5mg (500mcg)	10-20
Lormetazepam	0.5mg (500mcg) -1mg	10-12
Oxazepam	10mg	4-15
Nitrazepam	5mg	15-38
Temazepam	10mg	8-22
Zolpidem	10mg	2
Zopiclone	7.5mg	5-6

Adapted from the Ashton Manual, Maudsley Prescribing guidelines, UK Medicines Information Question and Answer.^69,84,87

*Clobazam and clonazepam may be prescribed for intractable epilepsy, caution if considering reducing dose.