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Benzodiazepine and z-drug withdrawal - Management
Additional information
- Dose conversion to diazepam:
- Diazepam 5 mg is approximately equivalent to [Ashton, 2002c; Sweetman, 2005; Taylor et al, 2007; BNF 56, 2008; Lader et al, 2009]:
- Alprazolam 0.25 mg
- Chlordiazepoxide 15 mg
- Clobazam 10 mg
- Clonazepam 0.25 mg
- Flurazepam 15 mg
- Loprazolam 0.5 mg to 1.0 mg
- Lorazepam 0.5 mg
- Lormetazepam 0.5 mg to 1.0 mg
- Nitrazepam 5 mg
- Oxazepam 15 mg
- Temazepam 10 mg
- Zaleplon 10 mg
- Zopiclone 7.5 mg
- Zolpidem 10 mg
- These equivalents are based on clinical experience and may vary between individuals [Ashton, 2002a; Lader et al, 2009].
- Diazepam is available in a variety of strengths (2 mg, 5 mg, and 10 mg) and formulations (scored tablets or liquid) to facilitate switching.
- Examples of switching schedules from the three commonest hypnotics to diazepam [Ashton, 2002c]:
- From temazepam 10 mg to diazepam 5 mg:
- Week 1: convert temazepam 10 mg straight to diazepam 5 mg.
- From temazepam 20 mg to diazepam 10 mg:
- Week 1: convert temazepam 20 mg to temazepam 10 mg and diazepam 5 mg.
- Week 2: convert remaining temazepam 10 mg to diazepam 5 mg, giving a total diazepam dose of 10 mg daily.
- From nitrazepam 5 mg to diazepam 5 mg:
- Week 1: convert nitrazepam 5 mg straight to diazepam 5 mg.
- From nitrazepam 10 mg to diazepam 10 mg:
- Week 1: convert nitrazepam 10 mg to nitrazepam 5 mg and diazepam 5 mg.
- Week 2: convert remaining nitrazepam 5 mg to diazepam 5 mg, giving a total diazepam dose of 10 mg daily.
- From zopiclone 7.5 mg to diazepam 5 mg:
- Week 1: convert zopiclone 7.5 mg straight to diazepam 5 mg.
- From zopiclone 15 mg to diazepam 10 mg:
- Week 1: convert zopiclone 15 mg to zopiclone 7.5 mg and diazepam 5 mg.
- Week 2: convert remaining zopiclone 7.5 mg to diazepam 5 mg, giving a total diazepam dose of 10 mg daily.
- Example of a conversion of an anxiolytic (lorazepam 1 mg three times daily) to diazepam [Ashton, 2002c]:
- Week 1:
- Morning: lorazepam 1 mg.
- Midday: lorazepam 1 mg.
- Evening: lorazepam 1 mg.
- Week 2:
- Morning: lorazepam 1 mg.
- Midday: lorazepam 1 mg.
- Evening: lorazepam 0.5 mg plus diazepam 5 mg.
- Week 3:
- Morning: lorazepam 0.5 mg plus diazepam 5 mg.
- Midday: lorazepam 1 mg.
- Evening: lorazepam 0.5 mg plus diazepam 5 mg.
- Week 4:
- Morning: lorazepam 0.5 mg plus diazepam 5 mg.
- Midday: lorazepam 1 mg.
- Evening: diazepam 10 mg.
- Week 5:
- Morning: diazepam 10 mg.
- Midday: lorazepam 1 mg.
- Evening: diazepam 10 mg.
- Week 6:
- Morning: diazepam 10 mg.
- Midday: lorazepam 0.5 mg plus diazepam 5 mg.
- Evening: diazepam 10 mg.
- Week 7:
- Morning: diazepam 10 mg.
- Midday: diazepam 10 mg.
- Evening: diazepam 10 mg.
- Week 8:
- Start diazepam withdrawal.
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