Switching from Lorazepam to Diazepam

Hi, all. I need some help with switching over from Lorazepam to Diazepam. I take .25 mg. of Lorazepam in the morning and I take .5mg at bedtime.  The most I ever took was 1.5 mg in a day. I have been trying to taper for a year and my body just doesn't want to let me. I have severe interdose withdrawals and all kinds of weird sensations. I can't drive and I can't work. Can you help with how much diazepam to take and how to substitute? My doctor said to take 1 10 mg Diazepam in the morning and 10 mg in the evening. I know that's not correct. Thank you.

Hi 06160501,

There is some debate about benzo equivalencies. I prefer to rely on the work of Dr. Ashton who ran a benzo recovery clinic for 12 years and her primary tapering method began with a short-to-long benzo cross to diazepam, like the one you are planning.

 

According to Dr. Ashton, 1mg of lorazepam can be substituted (gradually and step-wise) by 10mg of diazepam. So to get your Ashton-equivalent of diazepam, you only need to multiply your daily dose of lorazepam by 10. If you're currently using 0.75mg/day, this is a step-wise cross to 7.5mg of diazepam.

 

One reason your doctor might be trying to use a much much higher diazepam dose is because they want you to switch from one drug to the other all at once. I do not think this is a sensible or reliable way to cross, and I think a dramatic updose on diazepam is a reckless and ineffective solution to the problems it creates.

 

Basic pharmacokenetics predict that with substitution the lorazepam doses will be entirely eliminated by your body within days, while the diazepam doses may take a week or weeks to build to full potency; this can create a significant drop in GABA agonist blood serum levels and a spike in withdrawal symptom intensity and dysfunctions.

 

Please consider the Ashton Manual and her example slow-taper schedules like the one for 3mg of lorazepam here: https://www.benzoinfo.com/ashtonmanual/chapter2b/#schedule8 Dr. Ashton suggests using 6-steps, each 1 week apart, to slowly substitute a portion of each benzo dose with diazepam.

 

In your case, you might want to try a minimum of 3-steps, each time replacing 0.25mg of lorazepam with 2.5mg of diazepam, starting first with half of your PM dose. Here's an example of a 3-step crossover from 0.75mg lorazepam to diazepam (A for lorazepam, V for diazepam).

 

Step 1: 0.25mg A AM; 0.25mg A & 2.5mg V PM

Step 2: 0.25mg A AM; 5mg V PM

Step 3: 2.5mg V AM; 5mg V PM

 

I suggest to hold at each step until fully stabilized on the new substitutions; this can take 1 week or longer and I think your body will let you know if and when it's ready for the next step. I also suggest considering that this is a drug trial; if you're unable to stabilize on diazepam or you have debilitating new symptoms that appear to be caused by the diazepam, you may want to slow down or abandon the cross.

 

You could also do a 6-step cross if you had enough 0.5mg lorazepam tablets and could divide them into 1/4s. This slower process seems likely to be a more comfortable cross.

 

I hope you can find a way to ease your interdose withdrawal symptoms with a cross to diazepam. I think it is a significantly easier drug to taper, assuming you can tolerate it. Knowing about the blood serum level drop during each step of a short-to-long benzo cross will hopefully help you both to plan a more comfortable transition and better tolerate the uptick in symptom intensity that will most likely happen while you're body is adjusting to the new medication.

 

Let us know if you have more questions. I hope this helps. 

Thank you so much for your response. I am going to try the 6 step substitution. I have had such a hard time on the low dose of lorazepam so I know I need to take it slowly.

 

Thank you so much for your response. I am going to try the 6 step substitution. I have had such a hard time on the low dose of lorazepam so I know I need to take it slowly.

 

 

Great; I think you're making a good decision taking this slowly. 

 

I just realized that 6 even steps will require cutting 2mg diazepam tablets into 1/8ths. Ordinarily I do not advocate taking such small tablet divisions because I've never been able to do this reliably myself, however I believe that because diazepam has such a long half-life you will be able to get away with these 1/8th tablet pieces being slightly irregular from day to day. These small pieces are also only needed for every other step so I think the benefits of a 6-step transition will outweigh the risk.

 

I would personally cut a tablet to 1/4s and then use half of this accurately split 1/4 for one day and the other half (including all powder or crumbs) for the next, thereby getting the full and reasonably accurate 1/4 tablet over two days.

 

Here is an example 6-step cross from 0.75mg lorazepam to 7.5mg diazepam:

 

Step 1: 0.25mg A AM; 0.375mg A 1.25mg V PM

Step 2: 0.25mg A AM; 0.25mg A 2.5mg V PM

Step 3: 0.25mg A AM; 0.125mg A 3.75mg V PM

Step 4: 0.25mg A AM; 5mg V PM

Step 5: 0.125mg A 1.25mg V AM; 5mg V PM

Step 6: 2.5mg V AM; 5mg V PM

 

Please be aware that the last step of a step-wise cross is yet another adjustment period while the diazepam is building up in the blood to replace the lorazepam that has been removed.

 

A 6-step crossover at Dr. Ashton's suggested pacing will take 1.5 months or longer to complete. Is your doctor will to prescribe the lorazepam tablets concurrent with the diazepam?

Can you give me an example of the 6 part option? I'm staring at the Ashton schedule 3 and I'm wondering if I switch 25% at night the

first week and then another 25% at night the second week and  then start switching the morning. I have 45 .5 mg tablets of lorazepam left. Thanks again.

Thanks, I just saw that you posted a 6 part option!

I have 45 .5 mg tablets of lorazepam left.

 

Hi 06160501,

I think you have a good amount of lorazepam tablets to do a 6-step crossover. For this limited supply each step will need to be less than 2 weeks long, especially in the beginning. I calculated that, in the example crossover I wrote previously, if steps are 1 week long you'd need 27x 0.5mg tablets, and if your steps are 2 weeks long you'd need 53x 0.5mg tablets; so if you can average somewhere between 1-2 weeks per step I think you'll be fine.

 

Even though the pill-count matters, I suggest prioritizing listening to your body before taking each next step in the cross.

 

When do you intend to start your cross?

I am on my last week of substituting the diazepam for the lorazepam and am doing a lot better than expected.  I followed your 6 week substitution schedule.  Can you help me taper down from 2.5 mg of diazepam in the morning and 5 mg of diazepam at night?  I think I read that I should take a month on the 2.5 in the morning and the 5 in the evening before I try to taper. Is this what you suggest?  I really appreciate the help you have given me.

I am on my last week of substituting the diazepam for the lorazepam and am doing a lot better than expected.  I followed your 6 week substitution schedule.  Can you help me taper down from 2.5 mg of diazepam in the morning and 5 mg of diazepam at night?  I think I read that I should take a month on the 2.5 in the morning and the 5 in the evening before I try to taper. Is this what you suggest?  I really appreciate the help you have given me.

 

Hey 06160501! It's great to hear from you, and also with such good news. Congratulations on all your hard work crossing over; I'm glad you're seeing improvements. 

 

Yes, we can help you taper your diazepam doses, but I think finishing your cross should take priority for now. Once you've taken your last substitution and are fully on diazepam, I suggest holding for 1-2 weeks or until you're fully functional and have ironed out any kinks with dosing the diazepam before beginning to taper it. A month isn't necessary, IMO, unless you're struggling and need this time to stabilize.

 

What size are your diazepam tablets?