Posted by Quintal on December 25, 2006, at 14:47:18
In reply to Re: What Do You Do If You Develope A tolerance to » Quintal, posted by jimmygold70 on December 24, 2006, at 7:52:48
The usual equivalence ratio given for clonazepam/diazepam is 0.5mg/10mg so 3mg clonazepam ~ 60mg diazepam. From personal expereience I'd say this is true, though diazepam is more sedating and has a more pronounced hypnotic action per unit dose. This can cause problems for some people when they try to switch from shorter acting, less sedating benzos and Heather Ashton has some advice about this problem in this article:
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16. SHOULD I SWITCH TO ANOTHER BENZODIAZEPINE SUCH AS VALIUM BEFORE TAPERING?Keep in mind that some people feel that switching to Valium is not for everyone and many have tapered their drug of dependency and have recovered very well. However, if you are considering this recommended method, there are three reasons that are often cited for switching to Valium for purposes of withdrawal.
First, Valium has a far longer half-life than most other benzodiazepines (see above). This allows for a steady, smooth reduction in dose over time. It also permits you to take your dose less often. In some cases, you can take your entire daily dosage before bedtime. This reduces problems of micro-managing your dose by taking another pill every few hours. It also can aid in sleep, which can be a large issue during withdrawal.
Second, Valium is low in potency relative to most other benzodiazepines and comes in tablets of 2mg, 5mg and 10mg. As a practical matter, you can make cuts as small as 0.5mg. This is the equivalent of somewhere between 1/20th and 1/40th mg of Xanax or Klonopin. Given the importance of making the smallest cuts possible, particularly as you approach the end of your taper, this is a very large benefit.
Finally, some people, including some experts believe that the newer, high potency benzodiazepines such as Xanax, Klonopin, and Ativan tend to produce more severe withdrawal syndromes. So far the evidence of this is purely anecdotal. There do not appear to be any studies that conclusively correlate severity of withdrawal with benzodiazepine type.
If you do decide to switch to Valium it is important to observe the proper dose equivalencies. These are special equivalencies for purposes of switching to Valium. (see table above)
The cross-over process also needs to be carried out gradually, usually in stepwise fashion, substituting one dose at a time. Many people have suffered because they have been switched too quickly. Making the changeover one dose (or part of dose) at a time avoids this difficulty. Depending on the size of your dose, the period of dose substitution may be anywhere from 3 weeks to about 3 months.
Valium is a more potent sleep agent than most high potency benzodiazepines even at the equivalent therapeutic dose and many people may find it initially more sedating. However, most benzodiazepine users rapidly develop a tolerance to the sleep inducing (hypnotic) effects of benzodiazepines, so that it is likely that this oversedation will recede within the first few weeks.
During this period of dose substitution, sometimes cuts to your total dose are made, and other times, slight increases are made. If you experience extreme oversedation and no withdrawal symptoms, that is a sign that the equivalency dose is too high for you, and you may wish make a small cut in your total dose as you cross over. If, on the other hand, you begin to experience heightened withdrawal symptoms during cross-over, you may wish to make a small increase in your dose during cross-over. Because the proper equivalencies vary from person to person, the cross-over process can be a matter of trial and error. However, it is important to understand that the end result of switching to Valium should be that you are relatively stable after the switch is complete, meaning that you are experiencing either no withdrawal or very mild withdrawal symptoms.
Professor Ashton has circulated detailed protocols based upon switching to Valium and explaining the method in detail (see above and below).
Librium is another long acting benzodiazepine that is sometimes (but rarely) used as a substitute. This author has insufficient information regarding the effectiveness of Librium substitution to provide a meaningful comment at this time. It is not necessary to switch from Librium to Valium. Librium may be tapered directly, although there is a problem in that it comes only in 5mg capsules in North America. Ideally, for Librium withdrawal, the capsule should be opened and the contents halved to make 2.5mg cuts. Of course, if it is possible to make even smaller cuts, that is most preferable."
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poster:Quintal
thread:715139
URL: http://www.dr-bob.org/babble/20061224/msgs/716332.html