Benzodiazepines, or benzos, are a class of medications commonly used to treat anxiety, insomnia, and other conditions. However, even short-term or intermittent use can lead to physical dependence, and withdrawal can be challenging. One approach to withdrawing is to crossover to Valium, which the late Dr. Heather Asthon promoted in the Ashton Manual. Dr. Ashton ran a benzodiazepine clinic in the UK during the 1980s. She routinely transitioned her patients to Diazepam, the generic for Valium, as it is longer acting and comes in small doses, making tapering much more straightforward. In the years since the manual was published, the recommendation is to taper from one’s benzodiazepine if at all possible. In this blog post, we will discuss the process of crossing over to Valium during benzo withdrawal/BIND and the pros and cons of doing so.
Crossover Process
It is essential to approach this crossover process with caution. Rather than switching out the original benzodiazepine for Valium in one go, the process should be gradual, spanning over weeks or longer if need be. The initial medication is slowly reduced while Valium is progressively introduced. This approach allows the body time to adapt to the change, thus mitigating the risks associated with abrupt withdrawal.
It is crucial to swap the correct amount of Valium for the benzo that one is taking. Ativan is approximately ten times stronger than Valium, and Xanax and Klonopin are about twenty times stronger. You can Google benzo conversion chart and put in your benzo and dosage to find out what the approximate amount of Valium would be.
Symptoms and Challenges During the Crossover
While the Valium crossover can be helpful for some individuals, it’s important to acknowledge that it is not a perfect solution, and not everyone can make the transition successfully. Some people may become too symptomatic during the crossover process, experiencing worsened anxiety, insomnia, or other withdrawal symptoms. (I was unable to crossover to Valium from Clonazepam; the process made my withdrawal symptoms much worse.)
It’s also essential to recognize that there is nothing magical about Valium. It is still a benzodiazepine, and individuals undergoing the crossover process and afterward will continue to experience withdrawal symptoms. Valium may create more sedation and depression during withdrawal/BIND.
Furthermore, Valium may interfere with the production of diamine oxidase (DAO), an enzyme that breaks down histamine. This interference can lead to histamine intolerance in some individuals, which may manifest as allergy-like symptoms, such as itching, hives, or difficulty breathing.
Pros and Cons of the Valium Crossover
Pros:
- Gradual tapering: The Valium crossover allows for a more gradual tapering process due to its longer half-life compared to other benzodiazepines. This can help with inter-dose withdrawal one may experience on shorter-acting benzodiazepines such as Xanax and Ativan.
- Ashton Manual guidelines: The Ashton Manual provides a well-researched and structured approach to benzodiazepine withdrawal, making the crossover process more predictable.
Cons:
- Not suitable for everyone: Some people may be unable to successfully make the crossover due to worsened withdrawal symptoms.
- Continued withdrawal symptoms: As Valium is still a benzodiazepine, individuals undergoing the crossover process will continue to experience withdrawal symptoms.
- Increased sedation and depression: Valium’s longer half-life and its metabolites can result in more sedation and depression for some individuals, which may complicate the withdrawal process.
- Histamine intolerance: Valium’s interference with DAO production can lead to histamine intolerance in some people, which can further impact their quality of life during withdrawal.
- Valium breaks down into three metabolites, oxazepam, desmethyldiazepam, and temazepam, which can increase the drug’s duration, a problem for some, especially elderly users.
- Valium is known for causing severe depression in some individuals.
The Valium crossover, as outlined in the Ashton Manual, can be a helpful approach to managing benzo withdrawal for some individuals. Its lower dosage makes the mechanics of tapering easier, and its longer half-life potentially reduces interdose withdrawal symptoms. However, it’s essential to recognize that this method may not be suitable for everyone, and some individuals may not do well with a crossover. Crossing over to Valium will not guarantee a reduction in overall benzo withdrawal/BIND symptoms and, in fact, may increase them in some people. The only way out of benzo withdrawal/BIND is through, and most often, it is best to stay the course with your benzo and taper from it.
I’m on .25mg clonaze daily! Is every other day an option?
Thank you again for posting information on the crossover process. I recently had to switch generic brands from Solco to Teva. I am getting no effect from Teva and I’m in severe withdrawal after only one day. Is it true that generic brands can’t be 10% stronger or weaker and that is allowed from the FDA? So technically if Solco was 10% stronger than brand and Teva was 10% weaker than brand I have just made a 20% reduction? Why would the 3metabolites of Valium make it harder for the elderly? Thank you so much for all the great information!
I recently tried to begin switching over from Klonopin to Valium. I was taking 1 mg Klonopin three times daily ;I began at night by breaking 1 milligram Klonopin down to .5 and adding 10 mg Valium as stated in the Ashton manual. I woke the first and second day so severely depressed I had to discontinue the crossover.
I am sorry to hear, but I understand. Crossing to Valium doesn’t work for many of us. Thank you for sharing your experience with us.
The metabolites are benzos so it means that Valium is usually more sedating, which can mean more falls, etc., for the elderly. Generics can have a range of less or more active medication, so they are a bit less accurate perhaps. But many of us tapered off a generic and got free. I don’t think there is any way to know how much benzo is in your tablet, so all you can do is to follow your taper and keep heading toward the finish line. Thanks for your questions.
It is not advisable to take a benzo every other day. It seems to shock the brain and perhaps induce what is called kindling, although I am not sure that kindling would be the proper description.It is best to keep a steady dose of benzo in the bloodstream and to taper off slowly by reducing the dose, not by skipping doses or going without the med for a day or more.
I was crossed over to Valium from Bromazepam in one day. The psychiatrist got the equivalence right. Valium felt slightly less strong but other than a lot of sweating and the regular withdrawal symptoms I did not suffer overly. I’m happy I was switched to Valium because I was not managing at all to taper the Bromazepam. And Valium coming in liquid format allows more flexibility I think.
That is wonderful that it worked for you! This is a great example of “your mileage may vary.” The crossover is heaven for some, and hell for others. I am glad you found an easier way off benzos. Thank you for sharing your experience with us.
I am tapering clonazepam, I travel to another country for support the time is 4 hours ahead of U.S .A I am wonder 💭 how I take my meds and sleep 😴 habit .
I haven’t had that question asked before. I am hoping that some of the readers here who have had to travel can chime in. The general rule of thumb is that we should take our meds on a fairly tight schedule, but the time difference may mean you would do better to move your dosing times. As for sleep, I’d avoid any pills and let my body adjust to the time change naturally. A shout out to any travelers here: what have you done to deal with the time change issue? Please let us know.
this is discouraging. I had a LOT of hope with this possibility after all I’ve read. I tried valium to replace a dose of clonazepam and it was amazingly more potent to me and it scared me at actually. I took a 2.5 mg dose instead of a .125 dose of clonazepam ( I feel zero with low clonazepam) and felt completely stoned! I got cold in one hand and felt cold in general for a an hour or more. I don’t know if that was because I feared it. I had taken 1 mg or 2 of valium before during a procedure and was fine.
I even thought maybe I could convert the night time dose to valium as it seems more sedating (and powerful now as I’m naive to it) to me and keep my day time dose clonazepam and taper both over time. Trying with clonazepam on its own wrecked me…, irregular heart beats, afib came back, pins and needles, shocks, tinitus, vertigo, insomnia to the point of vomiting because I’ll go 2-3 nights in a row without sleeping- literally…, nausea, heart burn, unable to work. I was dropping 10% per month down to .05 three times a day. The panicked insomnia is what really did me in I believe.
I have been toying with the idea of trying to convert that nightime dose feeling i might sleep. Now I’m afraid of anything. I have a doc who has converted many people to valium and he said by far most have no issue, and the whole process is really not that bad if done the Ashton way for most.
Is he wrong???
It sounds like its not worth it now. I already know what its like tapering off clonazepam slowly. Debilitating for me. Feeling helpless and maybe staying on this half mg a day I’ve been on for years is better than the alternative. 🙁
I am sorry you’ve had such a rough time. A lot of people can’t make the cross over, and more doctors today are not insisting that their patients make the switch. I’m sure many people have made the switch successfully, but not everyone benefits. Only you can decide about your health choices with regard to benzos. The drugs are not supposed to be used long term, but only you can decide to taper off or stay on. I wish you the best as you go forward.
Thank you so much for the post and response!!!
I promise I won’t light up your posts with a million questions. I’ve never commented before and I do appreciate immensely what you are doing. So much so that if I decide to go down this path again I would like to have you in my corner with some ongoing sessions. (I can not entertain doing this alone again)
I’m really needing to know as much as possible before making decision (again)
Quick question while it hits me- Are you able in sessions to discuss the meds with us, supplements we may take and give us informative feedback based on whatever we experience? (not prescribe just offer knowledge and feedback).
I very much value your opinion ….Maybe you could address this part of my thought. I think it would be helpful to many others as well. This is the biggest deal for me and I think many on the journey (idea of valium switch)
I researched for weeks on end to find doctors all over the world who discovered Ashton, and found her methods to be by far the best solution, in particular the crossover to valium. So I found a new hope given my experience became somewhat dangerous (heart, vertigo, syncope, eroded esophagus etc.) after many weeks of being off clonazepam (I tapered off with some periodic nausea and heartburn but didn’t think much of it- It was MANY weeks later that everything happened and I went through every test there was only to find out it was PAWS). I then re introduced , tapered slower and the neurological and heart symptoms became out of control in the extreme low doses. All with a PC who I guess was in over her head.
I finally just found a doc who is much like yourself except he went through his withdrawal in a detox facility (a couple decades earlier) and suffered in a room while they basically watched him to make sure he didn’t die.
He is also wanting to make sure nobody he sees goes through that. He claims that “most” of his patients switch to valium (without even splitting a night time dose- they just switch) and really do rather well.
SO…., I found hope after all this research I’ve done and then his response gave me even more hope.
Reading this post has really taken the wind out of my sails but I need to know as much as I can so although disappointing for sure… informative, and I’m on a quest to know all I can.
Here’s my 3 questions- Do the majority of those who switch really do much better as stated by Ashton for decades and many others or has more knowledge now been gained and not so much?
Secondly, is it mostly the depression side of the switch that is the issue for some or is there much more?
Lastly- In your opinion would a valium taper by night (sedating and possibly depressing) and clonazepam tapering on day dose seem like a potentially positive perhaps innovative approach?
Thank you again. I truly apologize for the length of this comment but I feel many will benefit from you elaborating here as this (Ashton info and valium switch) is what brought myself and I’m sure many others to your site.
Blessings to you and what you are doing for us who are suffering.
I didn’t write the post to cause disappointment for anyone, but rather to provide information. The facts are what they are. Not everyone can manage a crossover, yet some people do better after a crossover. I can’t speak to the issue of the doctor who moves his patients to Valium with little problems. That hasn’t been the feedback I’ve gotten from my coaching clients over the last 12 years, nor was it my experience. I did an Ashton style crossover and it was horrible for me.
I’ll answer your three questions:
Here’s my 3 questions- Do the majority of those who switch really do much better as stated by Ashton for decades and many others or has more knowledge now been gained and not so much? NO. I don’t think that Valium is a magic wand. I have clients who switched and did worse. But some have done okay or even better. Your mileage may vary. Some doctors now don’t want to switch patients and prefer to taper from the current benzo. There are varied thoughts about the Valium crossover.
Secondly, is it mostly the depression side of the switch that is the issue for some or is there much more? There is more. Histamine, over sedation, more withdrawal symptoms, etc.
Lastly- In your opinion would a valium taper by night (sedating and possibly depressing) and clonazepam tapering on day dose seem like a potentially positive perhaps innovative approach? I believe the rule of thumb is that it is better to NOT be on two or more benzos.
Thank you again. I truly apologize for the length of this comment but I feel many will benefit from you elaborating here as this (Ashton info and valium switch) is what brought myself and I’m sure many others to your site. (Many of us in the benzo community would like to re-write parts of the Ashton Manual. We know so much more after 40 years and having the ability to share information so easily over the Internet.)
Blessings to you and what you are doing for us who are suffering. Thank you!
I was on Limbitrol for 30+ years when the company stopped making it. Got bad advice from new doctor to not go on anything. Was off meds for two months before finding new PCP. Psych nurse put me on clonazepam for a few weeks and then switched to diazepam using a tapered withdrawal starting with 2 milligrams. Pill was cut in to small pieces and taken throughout the day. I did this for 6 months. The whole ordeal was a nightmare and I never relaxed on the pill except for the first few days of being on it. I only was able to sleep 3 hours a night. I was referred to gastro doc because of acid reflux and spastic colon. He knew zero about treating me and I had bad reaction to standard med and went off it. PCP told me to get off the diazepam which I did tapering. After six months, I continued with bad side effects some of which lessened with time and others which took their sweet time in coming. Psych nurse said it would have taken her a year to get me off Limbitrol if they had still made the pill. Meanwhile, I had read Ashton and studied more information as well as had gotten some info from a nurse who had treated patients like me. Decided to stay off all meds unless there was something patients online had used that helped them. I went through too many PCPs during this time period because of moves and retirement. I now have a bright stable one who does not know a lot about benzos. I send him information and rely heavily on you as well as the benzo .org. that recommends you. My PCP does not know of anyone locally who would see me and be helpful. Nurses who treat us are done after treatment and send us back to our PCP. Psychiatrists in town want patients who are on meds and who have mental issues. Mine are physical issues. The system stinks! Doctor in the family talked to her fellow Harvard grad friend, psychiatrist, who works in an inpatient place in Boston. Her advice was the same as you are giving on the questions that I had. THANK YOU for saving so many of us!
You are most welcome!
I’m on lorazepam 1mg per day split into two doses. I’m in tolerance withdrawal, I’ve been on it for 14 months. I just get told by the psychiatrist that it’s my own anxiety getting worse when I know it’s this drug, I’ve also been diagnosed with bipolar but I feel like it’s this drug, I even have psychosis symptoms. I tried switching to diazepam and was made to do a straight swap. I lasted 4 days, by the fourth day I was so sedated I could barely stand up and my breathing felt very shallow, it was very frightening but the diazepam did seem to help with the derealization depersonalization that I get from the tolerance withdrawal from lorazepam. I’m torn, I just don’t know what to do. I’m in the UK. Do you offer appointments to those not in the US?
Thanks for this great site and dedicating your time to help others in this situation.
Jennifer I already have tons of food allergy issues, gerd, breathing issues, and I’m very underweight and I’ve been on 2mg lorazepam for two and half months per my psychiatrist.
My dosing is 0.5mg four times a day. How do I safely taper down slowly if I don’t want to risk crossover to valium because of the whole histamine thing?
The best thing would be to follow the Ashton Manual without the crossover. Look at the timing of the taper plan and see how you react to it. Many find that doing a daily micro taper is easiest on the nervous system. There are many videos available to watch for instruction on how to do one. Many doctors now reject the idea of moving everyone over to Valium. Remember, Ashton was a pioneer, and more info has been collected since her tapering clinics were established in the 1980s. We owe her such a debt of gratitude for opening the doors and paving the way, but we do know a bit more now. You can taper from Ativan. Millions have. I wish you the best!
I am sorry to hear that you are struggling so much. Many of us were told it was our underlying anxiety, or given a new psych diagnosis. I work with people from all around the world. Feel free to book a session or to join my group coaching/support group. I am here for you.
I was prescribed Ativan by my pcp. I was not using it as often as I should have for fear of addiction. After finding a good psychiatrist he switched me to Valium in one day. At first the dosage was not enough but we got it right. That was 10 months ago. Now I’m in the tapering phase.
I wish you all the best!