From the Research
When converting from Tranxene (clorazepate) to clonazepam, a general equivalency guideline is that 7.5 mg of clorazepate is approximately equivalent to 0.5 mg of clonazepam. This means that a patient taking 15 mg of Tranxene daily would typically be converted to about 1 mg of clonazepam daily. The conversion should be done gradually, typically reducing the original medication by 25% while adding the equivalent dose of the new medication, then progressively adjusting over 1-2 weeks to minimize withdrawal symptoms. It's essential to monitor the patient closely during this transition as individual responses vary. Both medications are benzodiazepines but have different half-lives—clonazepam has a longer half-life (30-40 hours) compared to clorazepate (metabolized to desmethyldiazepam with a half-life of 30-200 hours), which affects dosing frequency 1. Clonazepam is typically dosed twice daily while Tranxene may be given once daily. This conversion should always be supervised by a healthcare provider who can adjust the regimen based on the patient's specific response, medical history, and the reason for the medication change.
Some key points to consider during the conversion process include:
- The rate of development of tolerance to the benzodiazepines clorazepate and clonazepam against pentetrazole-induced seizures in mice was compared, with clorazepate leading to tolerance beginning at day 7 and clonazepam at the fourth day of treatment 2.
- Clonazepam not only blocked the increase in duration of self-sustained after-discharges (SSADs) but also suppressed and/or abolished SSADs in a dose-dependent manner, while clorazepate in the lowest dose used did not change SSADs 3.
- A study comparing the antiepileptic properties of carbamazepine and clonazepam found no significant differences between the two drugs during the 6 months of treatment 4.
However, the most relevant information for the conversion comes from the general equivalency guideline and the understanding of the pharmacokinetics and pharmacodynamics of both drugs, as well as the clinical experience with their use 5. The conversion from Tranxene to clonazepam should prioritize minimizing withdrawal symptoms and ensuring the patient's safety and comfort throughout the process. Given the lack of direct evidence on the conversion, the approach should be cautious and individualized, taking into account the patient's medical history, current condition, and response to the medication change.