What is the equivalent dose of diazepam for 0.5mg of Ativan (lorazepam) for a smoother taper?

Lorazepam to Diazepam Conversion for Tapering

For a patient taking 0.5 mg of lorazepam (Ativan) once daily, the equivalent dose for a smoother taper is 5-10 mg of diazepam. 1

Conversion Rationale

• The standard potency ratio between lorazepam and diazepam is approximately 1:10, meaning 0.5 mg of lorazepam is equivalent to approximately 5 mg of diazepam 1
• Some clinical contexts may require using a ratio closer to 1:20 (0.5 mg lorazepam = 10 mg diazepam) for patients who are particularly sensitive to withdrawal symptoms 2

Advantages of Diazepam for Tapering

• Diazepam has a longer half-life (20-100 hours) compared to lorazepam (10-20 hours), which creates a more gradual decline in blood levels 3
• The longer half-life of diazepam results in a smoother withdrawal experience with fewer interdose withdrawal symptoms 2
• Diazepam is available in multiple strengths (2 mg, 5 mg, 10 mg tablets), allowing for more precise dose reductions during tapering 4

Recommended Tapering Schedule

• Begin with 5 mg diazepam once daily as the equivalent starting dose 1
• Reduce the dose by approximately 10-25% every 1-2 weeks depending on patient tolerance 2
• A slower taper is recommended for patients who have been on benzodiazepines for longer than 8 weeks 2

Monitoring During Taper

• Monitor for withdrawal symptoms including anxiety, insomnia, irritability, tremor, and sensory hypersensitivity 2
• If withdrawal symptoms become significant, slow the taper by either reducing the percentage decrease or extending the time between dose reductions 4

Important Considerations and Pitfalls

• Avoid abrupt discontinuation of either medication as this can precipitate withdrawal syndrome, which may include seizures in susceptible individuals 4
• The elderly may be more sensitive to benzodiazepines and may require starting with a lower equivalent dose (2.5 mg diazepam) 5
• Patients with hepatic impairment may have decreased clearance of diazepam, requiring dose adjustments and closer monitoring 3
• Some patients may experience paradoxical agitation with benzodiazepines (occurs in approximately 10% of patients), requiring alternative approaches 5