Lorazepam Taper Conversion from Clonazepam
Convert the clonazepam taper to lorazepam using a 1:2.5 ratio (1 mg clonazepam = 2.5 mg lorazepam), resulting in the following schedule: lorazepam 2.5 mg QID x 2 weeks, 2.5 mg TID x 2 weeks, 2.5 mg BID x 2 weeks, 1.25 mg BID x 2 weeks, 1.25 mg daily x 1 week, 1.25 mg daily PRN x 1 week. 1
Conversion Rationale
The standard benzodiazepine equivalency ratio between clonazepam and lorazepam is approximately 1:2.5, meaning 1 mg of clonazepam equals approximately 2.5 mg of lorazepam based on potency differences between these high-potency benzodiazepines. 2, 1
This conversion maintains the same tapering structure and timeline as the original clonazepam regimen while accounting for the pharmacological differences between the two medications. 1
Converted Lorazepam Taper Schedule
- Week 1-2: Lorazepam 2.5 mg four times daily (total 10 mg/day) 1
- Week 3-4: Lorazepam 2.5 mg three times daily (total 7.5 mg/day) 1
- Week 5-6: Lorazepam 2.5 mg twice daily (total 5 mg/day) 1
- Week 7-8: Lorazepam 1.25 mg twice daily (total 2.5 mg/day) 1
- Week 9: Lorazepam 1.25 mg once daily 1
- Week 10: Lorazepam 1.25 mg once daily as needed 1
Critical Considerations for This Taper
The starting dose of 10 mg/day lorazepam exceeds the FDA-recommended maximum of 10 mg/day, which indicates the original clonazepam dose of 4 mg/day was quite high and this patient likely has significant benzodiazepine dependence requiring careful monitoring. 1
Lorazepam has a shorter half-life (10-20 hours) compared to clonazepam (18-50 hours), which means withdrawal symptoms may emerge more quickly between doses, making adherence to the scheduled dosing times more critical. 3, 4
Gradual dose reduction is essential to minimize withdrawal reactions including anxiety, tremor, insomnia, sweating, tachycardia, headache, and muscle aches, which are typically mild when tapered appropriately. 1, 3
Important Clinical Caveats
If the patient is elderly or debilitated, reduce all doses by 50% (starting at 1.25 mg QID instead of 2.5 mg QID) due to increased sensitivity to benzodiazepines and higher fall risk. 2, 1
Monitor for paradoxical agitation, which occurs in approximately 10% of patients treated with benzodiazepines, particularly during the taper phase. 2, 5
If withdrawal symptoms emerge during the taper, pause the reduction or increase back to the previous dose level, then resume tapering more slowly (e.g., extend each phase by an additional week). 1, 3
Avoid abrupt discontinuation or non-adherence, as this can lead to severe withdrawal symptoms, loss of benzodiazepine response, or require higher doses to regain control. 4
Cross-tapering between benzodiazepines can be challenging—some patients experience relapses when switching from lorazepam to other benzodiazepines or vice versa, so close monitoring throughout this converted taper is essential. 4