What is the equivalent dose of Clonazepam (clonazepam) for 1mg of Ativan (lorazepam)?

Lorazepam to Clonazepam Conversion

0.5 mg of clonazepam is equivalent to 1 mg of lorazepam.

Benzodiazepine Equivalence Ratios

When converting between benzodiazepines, it's important to understand their relative potencies to ensure appropriate dosing and minimize adverse effects. The conversion between lorazepam (Ativan) and clonazepam (Klonopin) follows a 2:1 ratio:

• 1 mg lorazepam = 0.5 mg clonazepam
• 2 mg lorazepam = 1 mg clonazepam
• 4 mg lorazepam = 2 mg clonazepam

Clinical Considerations

Duration of Action

While these medications are equivalent in potency at the doses mentioned, they differ significantly in their duration of action:

• Lorazepam has an intermediate duration of action (up to 72 hours) 1
• Clonazepam has a longer duration of action (approximately 24 hours) 1

Onset of Action

• Lorazepam has a more rapid onset of action compared to clonazepam
• Clonazepam's effects may take longer to manifest but persist longer in the system

Clinical Applications

Both medications are used for similar indications but may be preferred in different scenarios:

• Anxiety management: Both are effective, but dosing frequency differs

  • Lorazepam: Often dosed 0.5-1 mg up to four times daily as needed 2
  • Clonazepam: Typically dosed once or twice daily due to longer half-life

• Seizure control: Both medications can be used for seizure management, with clonazepam sometimes preferred for longer-term seizure control due to its extended duration of action 3, 1

Important Precautions

1. Respiratory depression risk: All benzodiazepines can cause respiratory depression, especially when combined with other sedative medications or in patients with respiratory conditions

2. Sedation: Monitor for excessive sedation when initiating therapy or changing between benzodiazepines

3. Elderly patients: Use lower doses in elderly or debilitated patients (typically half the standard adult dose) 2

4. Drug interactions: Avoid combining with other CNS depressants when possible, or use reduced doses when combination therapy is necessary

5. Withdrawal risk: Both medications carry risk of dependence and withdrawal; taper slowly when discontinuing

Practical Conversion Process

When converting from lorazepam to clonazepam:

1. Calculate the equivalent dose (divide lorazepam dose by 2)
2. Consider adjusting the dosing frequency (clonazepam is typically dosed less frequently)
3. Monitor patient response closely after conversion
4. Adjust as needed based on clinical response

Remember that individual patient factors including age, hepatic function, concomitant medications, and prior benzodiazepine exposure may necessitate dose adjustments beyond the standard conversion ratio.