What is the dosing tapering schedule to switch a patient from alprazolam (Xanax) 6mg to an equivalent dose of clonazepam (Klonopin)?

Benzodiazepine Conversion and Tapering Schedule: Alprazolam to Clonazepam

To safely switch a patient from alprazolam 6mg to clonazepam, implement a gradual cross-taper over 4-6 weeks, starting with 3mg clonazepam (0.5mg six times daily) while simultaneously reducing alprazolam by 0.5mg every 3-4 days until discontinuation.

Conversion Ratio and Initial Dosing

The appropriate conversion from alprazolam to clonazepam follows a 1:2 ratio (1mg alprazolam ≈ 2mg clonazepam). However, when dealing with higher doses like 6mg of alprazolam, a more conservative approach using a 1:0.5 ratio is recommended to prevent oversedation:

• 6mg alprazolam converts to approximately 3mg clonazepam initially

Detailed Cross-Tapering Schedule

Week 1:

• Start clonazepam 3mg total daily dose (0.5mg six times daily)
• Reduce alprazolam from 6mg to 5mg daily (divided doses)

Week 2:

• Maintain clonazepam at 3mg daily
• Reduce alprazolam to 4mg daily (divided doses)

Week 3:

• Maintain clonazepam at 3mg daily
• Reduce alprazolam to 2.5mg daily (divided doses)

Week 4:

• Maintain clonazepam at 3mg daily
• Reduce alprazolam to 1mg daily (divided doses)

Week 5:

• Maintain clonazepam at 3mg daily
• Discontinue alprazolam completely

Week 6 and beyond:

• Once stabilized on clonazepam only, consider gradual dose reduction of clonazepam if clinically appropriate (reduce by 0.25mg per week) 1

Key Clinical Considerations

• Monitoring frequency: Assess the patient weekly during the transition period for withdrawal symptoms
• Withdrawal symptoms to monitor: Anxiety, tremor, insomnia, nausea, sweating, tachycardia, headache, and muscle aches 1
• Slower tapering: If withdrawal symptoms emerge, slow the taper by maintaining the current dose for an additional week before proceeding
• Dosing distribution: Distribute clonazepam doses evenly throughout the day to minimize interdose withdrawal symptoms 2

Pharmacological Rationale

This approach leverages the pharmacokinetic differences between these medications:

• Alprazolam: Short half-life (11-15 hours), requires multiple daily dosing
• Clonazepam: Longer half-life (30-40 hours), provides more stable blood levels and smoother withdrawal

Common Pitfalls to Avoid

1. Avoid abrupt discontinuation of alprazolam as this significantly increases withdrawal risk, including seizures 3
2. Avoid too rapid tapering - the FDA recommends reducing alprazolam by no more than 0.5mg every 3 days 2
3. Don't underestimate high-dose dependence - patients on 6mg alprazolam daily may require a more gradual taper than standard recommendations
4. Don't overlook the need for frequent monitoring during the transition period
5. Avoid simultaneous rapid reduction of both medications, which increases withdrawal risk

If the patient experiences significant withdrawal symptoms despite this approach, consider extending the cross-taper period by slowing the alprazolam taper to 0.25mg reductions every 3-4 days while maintaining the clonazepam dose.