What is the equivalent dosage of clonazepam for a 5mg dose of Xanax (alprazolam) in an adult patient with a history of anxiety or panic disorders?

Benzodiazepine Dose Conversion: Alprazolam to Clonazepam

There is no standard 5mg dose of alprazolam (Xanax)—the maximum FDA-approved dose is 4mg daily for panic disorder, and 5mg would be considered excessive and potentially dangerous. However, if converting a theoretical 5mg alprazolam dose to clonazepam, the equivalent would be approximately 2.5mg clonazepam based on the established 2:1 conversion ratio.

Standard Conversion Ratio

The established conversion ratio between alprazolam and clonazepam is approximately 2:1, meaning 1mg of clonazepam equals roughly 2mg of alprazolam. 1

• Using this ratio, 5mg alprazolam would convert to approximately 2.5mg clonazepam 1
• This conversion applies most reliably for anxiolysis, sedation, and acute agitation management 1

Critical Safety Concerns with This Dose

A 5mg alprazolam dose significantly exceeds standard therapeutic ranges and raises serious safety concerns:

• The maximum recommended dose for panic disorder with alprazolam is 4mg daily, typically divided into multiple doses 2
• Alprazolam requires t.i.d. or q.i.d. dosing due to its shorter half-life, leading to interdose anxiety and rebound symptoms 3
• Patients on such high doses are at substantial risk for respiratory depression, especially when combined with other CNS depressants or opioids 1

Advantages of Switching to Clonazepam

Clonazepam offers significant clinical advantages over alprazolam, particularly at higher doses:

• Clonazepam has a dramatically longer half-life (30-40 hours) compared to alprazolam, allowing for once or twice daily dosing and eliminating interdose anxiety 1, 3
• In a clinical study of 48 panic disorder patients switched from alprazolam to clonazepam, 82% rated clonazepam as "better" due to decreased dosing frequency and lack of interdose anxiety 3
• Clonazepam can be considered a first-line agent for panic disorder with several advantages over other benzodiazepines 4

Practical Conversion Protocol

When converting from high-dose alprazolam to clonazepam:

• Start clonazepam at 2-2.5mg daily (divided into 2 doses initially) while gradually tapering alprazolam 1, 4
• Reduce alprazolam by 0.5mg every 3-5 days while maintaining stable clonazepam dosing 5
• Monitor closely for withdrawal symptoms including anxiety, tremor, insomnia, and autonomic hyperactivity 5

Monitoring Requirements and Precautions

Critical monitoring parameters during and after conversion:

• Monitor for morning sedation, early morning motor incoordination, confusion, memory dysfunction, and fall risk—all more common with clonazepam's long half-life 1
• Use particular caution in patients with obstructive sleep apnea, neurodegenerative disorders, or liver disease 1
• Monitor oxygen saturation and be prepared to provide respiratory support, especially during the conversion period when both medications may overlap 1
• Women may require higher doses than men to achieve the same clinical effect 1

Long-Term Considerations

For patients requiring chronic benzodiazepine therapy:

• Clonazepam exhibits a prophylactic effect against recurrence of depression when used long-term at lower doses 6
• Therapeutic doses for panic disorder typically range from 1-4mg daily, with most patients responding to 2-3mg daily 4
• If discontinuation is desired after long-term use, taper by 0.25mg per week after reaching 1mg daily to minimize withdrawal symptoms 5