2/3/2024 0 Comments Cloudytabs equivalentOther dosage forms, with a bioavailability of >90%, are assumed to have complete bioavailability for calculation purposes. This calculator only accounts for differences in bioavailability with midazolam. Note how the large variances in oral bioavailability highlight the significant inter-patient variability: Drug The following bioavailabilities are available based on published literature. Midazolam, lorazepam, diazepam, and phenobarbital are available in both parenteral and oral formulations.īecause published benzodiazepine dose conversions are based on oral administration, parenteral formulations may not use the same conversion ratio. Most benzodiazepines included in this calculator are only available as oral dosage forms. Given the numerous issues with benzodiazepine equivalence, the importance of reasonable clinical judgment, clinical experience, appropriate patient monitoring, and dose titration are of even greater significance. Lack of FDA oversight - Unlike opioid conversions, the FDA does not require manufacturers to describe equivalent dose or potency of benzodiazepines within the package insert.Benzodiazepine metabolism and excretion can differ significantly therefore, alterations in drug disposition will alter the relative potencies and durations of each benzodiazepine. Patient-specific factors - No equipotent conversion considers hepatic function, renal function, age, inter-patient metabolic variability, or drug interactions. ![]() Currently no conversion estimates capture this difference. Varying durations of action - Due to differences in half-life, active metabolites, and drug accumulation, benzodiazepine conversions should account for single-dose versus multiple-dose situations.In addition to an overall lack of evidence to support specific conversions, there are a number of other limitations that should be recognized: These wide ranges of confidence highlight the lack of firm, evidence-based literature supporting specific conversion ratios. Unless otherwise stated, all conversions are based on oral dosage formulationsĭue to discrepancies in the literature, many benzodiazepine conversions may have a potential conversion range that is extremely variable (eg, by a factor of 10x or greater).When equivalence discrepancies exist in the literature, a reasonable dose range is provided to emphasize the lack of confidence in the conversions.The following guiding principles govern the calculator's logic: 1, 2, 3, 4, 5, 6 The bulk of these publications come from an alcohol withdrawal setting using oral dosage forms. In fact, most benzodiazepine equivalence estimates are based on expert opinion, uncited tables in published documents, and clinical practice.Īll benzodiazepine conversions used in this calculator are based on published equipotent dose estimates. ![]() Unlike opioid equipotent dosing, benzodiazepine equivalence is much less evidence-based and poorly described in the literature. This conversion tool estimates a reasonable equipotent dose between two benzodiazepines.
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