Klonopin dosing schedule - should I change it?

I am taking Klonopin 1.25 mg at bedtime.  I am beginning the cross-over to Valium.  Does anyone have any experience, recommendations, references, or thoughts regarding whether I should break up my Klonopin dose over 2-3 times a day rather than once a day before I cross-over to Valium?  All of the references I've seen only give cross-over/taper schedules for 3 times a day dosing, so I'm not sure what would result in the least w/d severity. 

Thanks,

Paul

Hi,

If you are not suffering from problems with interdose withdrawal, then there is probably no point in changing your regimen now. After all, you are taking it because of insomnia - right!? You probably have enough on your plate with your substitution anyway. If you experience problems later (after you have switched to Valium), you might then switch to taking it twice a day instead. However, since Valium has a longer half-life than Klonopin, this probably won't be an issue. In short, I'd tackle one thing at a time, and don't anticipate problems that may well not occur.

Paul,

You are switching over to 12.5 mg of Valium from 1.25mg of Klonopin. shouldn't your conversion ratio be more like 25mg of valium?  double what you are converting.

Conversion:1.25 mg's of Klonopin is approximately equal to 25 mg's of Valium. The ratio of Klonopin to Valium is 1:20

Just a thought! 

Richie.

Paul,

 

You are switching over to 12.5 mg of Valium from 1.25mg of Klonopin. shouldn't your conversion ratio be more like 25mg of valium?  double what you are converting.

 

 

Conversion:1.25 mg's of Klonopin is approximately equal to 25 mg's of Valium. The ratio of Klonopin to Valium is 1:20

According to Ashton, this is true. However, different medical authorities state different equivalent therapeutic ratios. In the US, the standard equivalent would 10mg Valium to 1mg Klonopin (the ratio being followed by Paul). I feel that Professor ashton is probably nearer the mark when it comes to substitution of benzos, as she is experienced in prescribing substitution doses. I don't know why the equivalent in substitution would be different from an equivalent therapeutic dose, but this was the experience of Prof. Ashton.

However, when all said and done, equivalent doses (a ratio) should not be stated as a set number. Rather, it should be a range. This is because equivalent doses vary from individual to individual. This is because there is much greater accumulation in blood levels with longer half-life drugs. Since there is great variability in how long it takes someone to metabolise benzos, there will be great differences in blood levels for a long half-life benzo like Valium (half-life 36-200 hours), compared to something Xanax (half-life of 6-12 hours). It is not possible to give an exact equivalent dose between a drug where blood levels vary wildly for a given dose (as with Valium), and another, such as Xanax, where blood levels vary relatively little, no matter which end of the 6-12 hour half-life spectrum you lie.

There are other complications. Although all benzos have similar therapeutic effects, their relative strengths and weaknesses will vary with each therapeutic effect. So, you might require a slightly different equivalent dose depending on your reason for taking benzos (though I am guessing that this is relatively small effect compared to differing blood levels mentioned above).

This sounds pretty problematic, but the answer is pretty straightforward. Simply substitute a relatively small proportion of your benzo at a time, and adjust the equivalent dose to suit your needs. If this is not possible, allow plenty of time between substitutions so that you can adjust to any inaccuracy in what is prescribed and what is ideally required as an equivalent dose for you. If you are substituting a relatively small proportion of your dose, then any inaccuracy in the equivalency ratio is similarly reduced.