What is the equivalent dose of Valium (diazepam) for 1 mg of Xanax (alprazolam)?

Equivalent Dose of Diazepam (Valium) for 1 mg of Alprazolam (Xanax)

10 mg of diazepam (Valium) is equivalent to 1 mg of alprazolam (Xanax).

Benzodiazepine Equivalence Ratios

• Alprazolam is approximately 10 times more potent than diazepam, making the conversion ratio 1:10 1
• When converting from alprazolam to diazepam, multiply the alprazolam dose by 10 to determine the equivalent diazepam dose 1

Clinical Considerations When Converting Between Benzodiazepines

• Pharmacokinetic differences between these medications should be considered:

  • Alprazolam has a shorter half-life (12-15 hours) compared to diazepam (20-100 hours) 2
  • Diazepam has active metabolites that significantly prolong its duration of action, especially in elderly patients 3
  • Onset of action differs: alprazolam takes effect in 1-2 hours while diazepam's onset is more rapid at 1-2 minutes when given intravenously 1

• When switching between benzodiazepines, consider:

  • Gradual cross-titration to minimize withdrawal symptoms 1
  • Monitoring for changes in sedation level due to different potencies 1
  • Potential for drug interactions (e.g., medications affecting cytochrome P450 enzymes) 2

Special Population Considerations

• Elderly patients require dose reductions for both medications:

  • Diazepam's half-life can be significantly prolonged in elderly patients (up to 86 hours vs 31 hours in younger adults) 3
  • Elderly patients may need a 50% or greater dose reduction when using either medication 1

• Patients with hepatic impairment:

  • Both medications undergo hepatic metabolism and may accumulate in patients with liver disease 2
  • More frequent monitoring is recommended when converting between these medications in patients with hepatic dysfunction

Common Pitfalls in Benzodiazepine Conversion

• Underestimating the potency difference can lead to over-sedation when switching from alprazolam to diazepam 1
• Failing to account for the longer half-life of diazepam may result in cumulative effects with repeated dosing 3
• Not recognizing that withdrawal symptoms may be more likely when switching from short-acting alprazolam to longer-acting diazepam without proper tapering 1