Benzodiazepine Equivalence

Intermediate Acting: 

• Peak: 1-2 hrs
• Half-life: 6-12hrs
• Use: anxiolytic

• Peak: 2 hrs
• Half-life: 12 hrs
• Use: anxiolytic, anticonvulsant, hypnotic

• Peak: 1-4 hrs
• Half-life: 30-40 hrs
• Use: anxiolytic, anticonvulsant

• Peak: 1-2 hrs
• Half-life: 8-10 hrs
• Use: anxiolytic, hypnotic

Long Acting:

• Peak: 1-1.5 hrs
• Half-life: 48-100 hrs (active metabolite up to 200 hrs)
• Use: anxiolytic, muscle relaxant, anticonvulsant

• Peak: 2- 4 hrs
• Half-life: 24-48 hrs.  (active metabolite up to 200 hrs)
• Use: anxiolytic, alcohol withdrawal

Notes:

• 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).

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. Medscape Benzodiazepine Equivalence Table; July 2018; Table
4. Management Of Benzodiazepine Withdrawal; Government Of South Australia; SA Health; WS2.4 Handout