Clonazepam 500mcg Diazepam Equivalent Dose
Clonazepam 500mcg (0.5mg) is equivalent to approximately 10mg of diazepam. 1, 2
Benzodiazepine Equivalency Ratio
- The standard conversion ratio is 0.5mg clonazepam = 10mg diazepam, representing a potency ratio of approximately 20:1 1, 2
- This equivalency is recommended by the American College of Emergency Physicians and the American Geriatrics Society 1, 2
Key Pharmacological Differences to Consider
When interpreting this equivalency, understand that these medications differ substantially beyond simple dose conversion:
- Half-life: Clonazepam has an elimination half-life of 30-40 hours, while diazepam and its active metabolites persist even longer, resulting in different accumulation patterns 3, 2
- Absorption: Clonazepam reaches maximum plasma concentrations within 1-4 hours with 90% bioavailability 3, 2
- Clinical effect: Despite equivalent dosing, clonazepam produces more pronounced morning sedation and early morning motor incoordination compared to diazepam 1
Clinical Implications of This Conversion
- Side effect profile differs: Clonazepam at 0.5-1.0mg carries risk of worsening sleep apnea, confusion, memory dysfunction, and falls—particularly concerning in older adults 3, 1
- Not a simple 1:1 substitution: If switching between these medications, a gradual cross-taper approach over 2-4 weeks is recommended, often with an initial 25-50% dose reduction when transitioning to clonazepam 1, 2
- Respiratory caution: Both medications increase respiratory depression risk, especially when combined with opioids or other CNS depressants 2