Anxiety

[Guest]

Dr.,

I have seen frequent references to benzodiazepines in terms of "diazepam equivalents" with regard to discontinuance.

Two questions:
1. Why are other benzos measured in terms of diazepam equivalents with regards to discontinuance?

2. What are the Diazepam equivalents of clonazepam and alprazolam?

Thanks as always.

[Guest]

Diazepam (Valium) was one of the first and most popular agents. Doctors got used to using it and were familiar with its effects at various doses. The newer (now old) agents were of different potencies but identically effective. Converting the doses to the equivalent of diazepam gives the doctor a handle on how powerful a dose of a less familiar agent is. Figuring out equivalence is part scientific and part clinical. The equivalence in a testube is not identical to the equivalence in a biologic system. That is why you see different figures bandied about as equivalent. It depends on what tests were used to measure equivalence and not all tests give the same answers. In general 10 mg of diazepam equals 1 mg of alprazolam or clonazepam; it is another way of saying that these agents are about ten times as potent. I have seen some figures that state the potency of alprazolam and clonzazepam as equal and some showing increased potency of clonazepam. So if a doctor is used to going down by 5 mg a day of diazepam for a week, he/she would reduce the other agents by 0.5 mg a day. It is a clinically useful but rough guide as to how to handle these agents with different potency. Not all agents are more potent, some like Librium or Tranxene are less potent. Potency has absolutely nothing to do with effectiveness. They are all identically effective at equivalent doses.
[quote] Dr. ,

I have seen frequent references to benzodiazepines in terms of "diazepam equivalents" with regard to discontinuance... [/quote]