Why Switch To Diazepam to taper? The Ashton Protocol recommends switching short half life benzos over to diazepam because: it is one of the most slowly eliminated benzodiazepines with a half-life of up to hours. This longer half life is a clear advantage for those who are tapering as the blood level for each dose falls by only one half in about 8. This is called inter-dose withdrawal it comes in readily available small dosage strengths making it easier to taper from.
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Conversion of IV Midazolam Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients. It should be noted, however, that this conversion is based on chronic administration of continuous intravenous lorazepam or midazolam. Phenobarbital and Secobarbital Although phenobarbital and secobarbital are not benzodiazepines, they are commonly grouped with this drug class and cited within benzodiazepine conversion charts due to their use in alcohol withdrawal.
While barbiturates do share similar pharmacology to benzodiazepines, they have a more concerning safety profile with a higher incidence of respiratory depression. Management of withdrawal syndromes and relapse prevention in drug and alcohol dependence. Am Fam Physician. PMID Quan D. Chapter New York: McGraw-Hill; Evaluation of an alcohol withdrawal protocol and a preprinted order set at a tertiary care hospital.
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