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Institute of Psychiatry - 1 North
                    
Medication Equivalencies

Benzodiazepine Equivalents (to 1mg lorazepam)

Drug Name (Trade Name)

Equivalent Dose*

Half-Life**

Alprazolam (Xanax)

0.5 mg

Medium (12 hrs)

Chlordiazepoxide (Librium)

10 mg

Extended

Clonazepam (Klonopin)

0.25 mg

Long

Clorazepate (Tranxene)

7.5 mg

Extended

Diazepam (Valium)

5 mg

Extended

Flurazepam (Dalmane)

5 mg

Extended

Lorazepam (Ativan)

1 mg

Medium (15 hrs)

Midazolam (Versed)

1.5 mg

Short

Oxazepam (Serax)

15 mg

Medium (8 hrs)

Temazepam (Restoril)

7.5 mg

Medium (11 hrs)

Triazoam (Halcion)

0.125 mg

Short

Notes: All benzos have peak plasma levels at 1-2 hrs.
Lorazepam and oxazepam have no liver metabolism, the rest do.
*Must take into account half-life / dosing frequency when calculating equivalent daily dose.
**Average half-life of all active metabolites, where Short = <3 hrs, Medium = 8-15hrs (and actual half-life given in parentheses), Long = >24hrs, Extended = >72hrs.

Analgesic Equivalents (to 1mg po morphine)

Drug Name

(Trade Name)

Oral Dose

(mg)*

Dose

Frequency

Max Daily Dose (mg)

Notes

Non-opioids

Acetaminophen (Tylenol)

130

q4-6hr

4000

Aspirin (generic)

130

q4hr

4000

Celecoxib (Celebrex)

20

daily-bid

400

COX2 inhibitor

Diclofenac (Voltaren)

5

bid-tid

150

Diflusinal (Dolobid)

50

q12hr

1500

Etodolac (Lodine)

30

q6-8hr

1200

Fenoprofen (generic)

40

q6-8hr

3200

Ibuprofen (Motrin)

40

q6-8hr

3200

Indomethacin (Indocin)

5

bid-tid

100

Ketoprofen (Orudis)

5

q6-8hr

300

Meloxicam (Mobic)

1.5

daily

15

Naproxen (Naprosyn, Aleve)

50

q12hr

1250

Rofecoxib (Vioxx)

5

daily

50

COX2 inhibitor

Valdecoxib (Bextra)

2

daily

40

COX2 inhibitor

opioids

Codeine (generic)

6.66

q4hr

None unless combo form

Lots of N/V, constipation. Combo form Tylenol #2-4. Not for chronic use.

Fentanyl transdermal (Duragesic)

NA

q72hrs

None

Transdermal form of 0.55 mcg/hr equivalent to 1mg po morphine

Hydrocodone (Lortab, Lorcet, Vicoprofen, Vicodin)

1

q4-6hr

Limited by combo agent

Only available in combo form with acetaminophen, ibuprofen or aspirin.

Hydromorphone (Dilaudid)

0.25

q4hr

None

5mg po = 1mg IV/IM form

Meperidine (Demerol)

10

q4hr

Limited

Has CNS toxic metabolite. Not for chronic use.

Methadone

(Dolophine, Methadose)

0.08 to 0.25

q4hr (pain)

daily (addiction)

None

Intraindividual variability, titration to be done by experienced clinician

Morphine immediate release

(MSIR)

1

q4hr

None

3mg po = 1mg IV. Significant histamine release with drop in BP, puritis, esp with IV form.

Morphine controlled release

(MS Contin)

1

q12hr

None

Cheaper than OxyContin

Oxycodone immed release

(generic, Roxicodone, OxyIR)

0.66

q4hr

None unless combo form

Combo form Percocet (acetaminophen), Percodan (ASA)

Oxycodone controlled release

(OxyContin)

0.66

q12hr

None

Propoxyphene HCl (Darvon)

12

q4hr

390

Toxic metabolite. Not for chronic use.

Propoxyphene napsylate (Darvon-N)

18

q4hr

600

Combo form Darvocet (with acetominophen). Toxic metabolite. Not for chronic use.

Tramadol (Ultram)

5

q4hr

400

Both opioid / non-opioid properties. Uncertain addictive potential.

*Must take into account half-life / dosing frequency when calculating equivalent daily dose. So, for example, 15 mg MS Contin bid is equivalent to 5mg MSIR q4hrs.