It is very typical for patients taking benzodiazepines like Klonopin(clonazepam), Ativan (lorazepam) or Xanax (alprazolam) to be advised that they are on a low dose benzodiazepine. This is frequently misleading. Patients are told many different doses are “low dose”. Even in studies low dose is subjective or often used without a quantifying amount.
Because certain benzodiazepines are dosed in amounts that may sound “low dose”. For example, 0.5 milligrams of Klonopin, 1 milligram of Ativan and 0.5 mg of Xanax are equivalent to 10 milligrams of Valium. This means that 0.5 mg of Klonopin, Xanax or Ativan may likely require a lengthly taper for safe cessation.
According to Dr. Ashton, a medical expert on benzodiazepines and withdrawal, a safe dose to stop Valium after approximately a 40 week (or longer) taper is 0.5 to 1 mg of Valium, or lower. This is equivalent to around 0.05 to 0.10 mg of Klonopin and Xanax or 0.10 to 0.20 mg of Ativan. It is important to note the lowest doses to stop Klonopin, Ativan and Xanax are unavailable commercially and are at minimum 10-20x more potent than the safest, lowest recommended dose to stop a benzodiazepine.
The term low dose can be very misleading to patients. There are two possible common outcomes to a low dose that are concerning. The first being the developement of tolerance to the “low dose” which may lead to withdrawal symptoms often mistaken for the return of the patient’s underlying issues. This frequently results in prescribers increasing the dose and/or prescribing additional medications. The second outcome is cessation, which can cause problems and disability when a benzodiazepine is taken at either a low dose or a higher dose. The feelings of security of believing one is on a low dose are often found to be false, and the patient ends up confused, on multiple medications believing they cannot be experiencing symptoms on such a low dose, or surprised to find out their low dose wasn’t that low at all.
All patients deserve informed consent, regardless of the perception of the size of the dosage, because every dosage has the potential for tolerance, dependence and long term injury.
Janice is a graduate of the University of South Florida. Prior to becoming sick from benzodiazepines she was working on her Masters in Clinical Psychology. She founded Benzodiazepine Information Coalition in 2016 after sustaining a multi year injury from prescription Ativan taken as instructed by her physician. She experienced severe side effects from the drug and was misdiagnosed, over a 5 year period, with a multitude of health problems from multiple specialists unable to consider benzodiazepines as the culprit. When she finally discovered the cause of these problems she was unable to find a physician, despite multiple consultations, capable of tapering her off the drug. Fortunately she was able to find this information online from other laypeople who had experienced the same problem. Shocked with, and confused by, the widespread lack of knowledge within the medical community about such a commonly prescribed class of drugs, along with a feeling of indebtedness towards the prescribed harm community that saved her, she decided to organize and form a coalition to facilitate information sharing, awareness, education, research and change.