Q. Patient Overdosed on 10 Xanax and 20 Klonopin Pills.

Q. Patient presented to ER after overdosing on 10 Xanax (Alprazolam) and 20 Klonopin (Clonazepam) Pills.
This is equivalent to how many mg of Lorazepam?

(a) 5mg Lorazepam
(b) 10mg Lorazepam
(c) 30mg Lorazepam
(d) 40mg Lorazepam
(e) 50mg Lorazepam
(f) 60mg Lorazepam

Various sources will cite different lorazepam equivalents. There is a nice table in Kaplan and Saddock outlining them. I tend to follow Ashton (google Ashton manual). I would consider xanax 1mg equivalent to lorazepam 2mg and clonazepam 1mg equivalent to lorazepam 2mg. Sometimes xanax is given a 1:1 ratio with lorazepam and clonazepam can be given a 0.25:1 (clonazepam 0.25 mg = lorazepam 1mg).

The problem with these conversions is that you have to account for rate of absorption, volume of distribution, half-life, and area under the curve, which is easier said than done.

So my answer choice of lorazepam 60mg is not on the list, but I gather you are counting alprazolam as 1:1 and clonazepam as 0.5:1, making the answer lorazepam 50mg?

A very important post. Given the large variation in equivalency data, we should be vigilant about benzo tapers and cross-tapers, and watch for signs of withdrawal.

My mistake here. I apologize for not giving 60mg option in choices, and also for not specifying the doses of Klonopin & Xanax. Both are 1 mg each.

Answer= 60mg Lorazepam.

Benzodiazepines Equivalents:
Lorazepam 1 mg= Alprazolam 0.5mg= Clonazepam 0.25mg= Diazepam 5mg= Oxazepam 25mg

10 Aplrazolam pills (1mg)= 20mg Lorazepam
20 Clonazepam pills (1mg)= 40mg Lorazepam
Total= 60mg Lorazepam.

I agree that rate of absorption, volume of distribution & half-life will influence the total dose.

Thanks for Ashton manual reference.

Is 60 mg Ativan is :rite ans??
20 mg Clonazepam= 80 mg lorazepam
.25 mg Clonazepam = 1 mg lorazepam ?
so it means 1 mg Clonazepam = 4 mg lorazepam
so 20x4 =80 Lorazepam.

10 mg xanax= 20 Lorazepam
total 100mg Lorazepam ????

Clonazepam 0.5 = Lorazapam 1mg (according to Ashton)

But in some sources you will see clonazepam 0.25mg = lorazepam 1mg

I tend to agree with Ashton as per my clinical experience.