Benzodiazepine Oral Equivalence

Drug

Oral Dose

Peak

Half-life

Use

Alprazolam

(Xanax)

0.5 mg PO

1-2 hrs

6-12 hrs.

Anxiolytic

Chlordiazepoxide

(Librium)

25 mg PO

2-4 hrs

24-48 hrs 

(active metabolite up to 200 hrs)


Alcohol Withdrawal

Anxiolytic

Clonazepam

(Klonopin)

0.5 mg PO

1-4 hrs

30-40 hrs

Anticonvulsant

Anxiolytic

Diazepam

(Valium)

5 mg PO

1-1.5 hrs

48-100 hrs

(active metabolite up to 200 hrs)

Alcohol Withdrawal

Anticonvulsant

Anxiolytic

Muscle Relaxant

Lorazepam

(Ativan)

1 mg PO

2 hrs

12 hrs

Alcohol Withdrawal

Anticonvulsant

Anxiolytic


Hypnotic

Temazepam

(Restoril)

10 mg PO

1-2 hrs

8-10 hrs

Anxiolytic

Hypnotic

  • Hypnotics are used to induce sleep
  • There is considerable variability in the reported ranges for peak concentration and half-life. Wherever possible, data is extracted from package inserts.
  • Long-acting benzodiazepines have active metabolites.
  • Dosing listed above is for equivalence in ORAL administration only.
  • Careful consideration should be given to patient age, liver function, and co-ingestion of metabolic inhibitors or other non-benzodiazepine sedative medications (opioids, alcohol, etc).

Further Reading

Alcohol Withdrawal Syndrome: Improving Outcomes in the Emergency Department With Aggressive Management Strategies – Pharmacology EXTRA Supplement – (Pharmacology CME) Date Release: Mar 2021. This Pharmacology EXTRA CME supplement (free to Emergency Medicine Practice subscribers) reviews the management of alcohol withdrawal syndrome.

Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition and Treatment Date Release: Mar 2017. A review of the pathophysiology, diagnostic decision-making tools, and pharmaceutical treatment options to create a patient-tailored approach to sedative-hypnotic withdrawal.

Nonconvulsive Status Epilepticus: Overlooked and Undertreated (Pharmacology CME) Date Release: Oct 2019. Altered mental status is a common presentation in the ED, and time is of the essence in diagnosing NCSE and halting seizure activity.

References

  1. Benzodiazepines: How They Work And How To Withdraw (aka The Ashton Manual), Chapter : The Benzodiazepines, What They Do In The Body;  Online Manual
  2. DailyMed, Official Provider of FDA Label Information; Website
  3. Management Of Benzodiazepine Withdrawal; Government Of South Australia; SA Health; WS2.4 Handout

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