It is very typical for patients taking benzodiazepines to be advised that they are on a low dose benzodiazepine such as Klonopin, Valium, Ativan, or Xanax. Unable to quantify what a low dose actually is due to variations in patient experience, I went looking for answers. What I found, even in studies, is that low dose is subjective, or often used without a quantifying amount.
Because certain benzodiazepines are dosed in amounts that may sound “low dose”, such as lorazepam (Ativan), clonazepam (Klonopin) and alprazolam (Xanax), the dosages can be misleading. 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 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 taper is 0.5 -1 mg of Valium (or it’s equivalent). It is important to note the lowest doses available for Klonopin, Ativan and Xanax are at minimum 10-20x more potent than the safest, lowest recommended dose to stop a benzodiazepine, which is about .5 to 2 mg of Valium.
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 Curle was working on her Masters in Clinical Psychology when she became disabled by taking Ativan as prescribed by her physician. She founded Benzodiazepine Information Coalition in 2016 to facilitate awareness, education, research and change.