Substitution Table

[[Buddie]]

I tried to do a substitution taper and ran into a similar problem as Waltor.  I'm wondering if this is the reason.  I got into a rather heated discussion with my Dr. about what was the correct dosage.  He sent me this print out from his hospital.  THe top reads "Equivalent sedative hypnotic medication doses."  One column is entitled Dose Intervals (hours) it list Klonopin as 8 and Diazepam as 6.  The second column is entitled "Equivalent oral dose (mg) it list Klonopin as 2 and Diazepam as 10.  Now I know that Valium has a high sedative effect than Klonopin.  Yet the pharmacist I went to told me that the substitution was 8-10 mg for every .5 of Klonopin.  My doc. insists it should be 10mg. of Diazepam for 2mg Klonopin.  I'm at a loss to explain his schedule.  Anyone else have any clue how to make sense of this or is it just wrong?

[[Buddie]]

Hi [...],

Check out this table on our site. It's the second one down at this link

http://www.benzobuddies.org/buddiesguide/tables

There are many different schools of thought but it is generally believed the most accurate equivalence guide is  Prof. Ashton's.

So your pharmacist is probably closer to the truth here, but everyone has a different chemistry and metabolism, and it's possible that some may do fine on the crossover your doctor is suggesting. 

[[Buddie]]

My doctor suggests I should be able to substitute 8mg (2mg 4X a day) for 1.5 mg (.5 3X a day).  That isn't even close.  I tried it the first night and it was a disaster.  I woke up with the worst headache and tinnitus of my life.  I'm trying to get him on board.  I just don't understand his equivalency and how it can differ so vastly from everything else I'm reading.

[[Buddie]]

Have you told him what your pharmacist says? Also, if you haven't already, print him Dr. Ashtons equiv. chart. Here is a printable version. http://www.benzo.org.uk/bzequiv.htm

[[Buddie]]

Hi,

I have no idea why Valium is scheduled to be taken every six hours when it has a very long half-life (36-200 hours). Valium need not be taken more than twice a day. Klonopin has an averagingly-long half-life (18-50 hours), so most of our members take it three times per day, but many are fine taking it just twice.

Different sources recommend differing equivalent doses. Ashton equates about 20mg Valium to 1mg Klonopin, but some disagree. However, I note that more sources are beginning to equate 20mg Valium to 1mg Klonopin, including the Clinical Handbook of Psychotropic Drugs, 4th revised edition, Bezchlibnyk-Butler et al. editors (Clarke Institute of Psychiatry, Toronto), Hogrefe & Huber, which should be a good enough source for any GP.

What constitutes an equivalent dose will vary from individual to individual, but I think your pharmacist is going to much closer the mark.

[[Buddie]]

[...],

I've posted a question to you, along with some answers here.
http://www.benzobuddies.org/forum/index.php?topic=9085.msg115410#msg115410

It's best if we try and stick with one thread for now.