From the FDA Drug Label
DOSAGE AND ADMINISTRATION Dosage should be individualized for maximum beneficial effect. ADULTS: USUAL DAILY DOSE: Management of Anxiety Disorders and Relief of Symptoms of Anxiety Depending upon severity of symptoms—2 mg to 10 mg, 2 to 4 times daily
To transition from lorazepam 1mg to diazepam, the equivalent diazepam dose is not directly stated in the label.
- Diazepam dosing should be individualized for maximum beneficial effect, with usual daily doses ranging from 2 mg to 10 mg, 2 to 4 times daily for anxiety disorders.
- Since there is no direct information on transitioning from lorazepam to diazepam, a conservative approach would be to start with a low dose of diazepam, such as 2 mg, 2 to 4 times daily, and adjust as needed and tolerated 1.
From the Research
To transition from lorazepam 1mg to diazepam, use a conversion ratio of 1:10, meaning 1mg of lorazepam is equivalent to approximately 10mg of diazepam, as supported by the general understanding of benzodiazepine pharmacology, although a specific study directly addressing this conversion is not provided in the given evidence. For a patient taking lorazepam 1mg, the equivalent diazepam dose would be 10mg. This transition should be done gradually to minimize withdrawal symptoms. A common approach is to reduce the lorazepam by 0.25mg while adding 2.5mg of diazepam every 1-2 weeks. For example, start with lorazepam 0.75mg plus diazepam 2.5mg, then lorazepam 0.5mg plus diazepam 5mg, then lorazepam 0.25mg plus diazepam 7.5mg, and finally diazepam 10mg alone. This gradual transition works because diazepam has a longer half-life (20-100 hours) compared to lorazepam (10-20 hours), which helps prevent withdrawal symptoms, as can be inferred from the pharmacokinetic properties of benzodiazepines discussed in studies like 2. Diazepam's active metabolites also provide a smoother transition. During this process, monitor for excessive sedation, confusion, or breakthrough anxiety, and adjust the schedule as needed. Once stabilized on diazepam, any subsequent tapering for discontinuation can be done more gradually due to diazepam's availability in smaller dose increments and its longer duration of action.
Key Considerations
- The conversion ratio and gradual transition approach are based on general clinical practice guidelines and the pharmacological properties of lorazepam and diazepam.
- Monitoring for adverse effects and adjusting the transition schedule as needed is crucial for patient safety and comfort.
- The metabolic pathways of benzodiazepines, including glucuronidation and hydroxylation as noted in 3, can influence their pharmacokinetics but do not directly impact the conversion ratio in this context.
- Studies on benzodiazepine receptor occupancy and the effects of different benzodiazepines on cytochrome P450 enzymes, such as those discussed in 2 and 4, provide valuable insights into the pharmacodynamics and potential drug interactions but do not alter the fundamental approach to transitioning between lorazepam and diazepam.
Transition Steps
- Start with lorazepam 0.75mg plus diazepam 2.5mg.
- Progress to lorazepam 0.5mg plus diazepam 5mg.
- Then, lorazepam 0.25mg plus diazepam 7.5mg.
- Finally, diazepam 10mg alone, adjusting the schedule based on patient response and potential side effects.