Key takeaways
- A crossover from Klonopin to Valium can go wrong in two directions, too much diazepam or too little.
- Drowsiness that grows over a week or two usually means diazepam is building up, because it accumulates slowly.
- Holding steady is often the first step, since diazepam takes a week or two or more to settle after any change.
- The diazepam dose can be adjusted, because conversion tables are rough estimates that differ from person to person.
- Turning a sudden switch back into a gradual crossover, with both drugs for a while, is a recognized option.
- If diazepam does not suit someone, going back to Klonopin and tapering from it is a sound choice.
- Any change is made gradually with the prescriber, never by stopping abruptly.
The switch from Klonopin to Valium is not working. What now?
A crossover taper replaces a shorter-acting benzodiazepine such as Klonopin, or clonazepam, with the longer-acting Valium, or diazepam, and then tapers the diazepam. It is the method Professor C. Heather Ashton laid out in Chapter II of the Ashton Manual, free to read at benzo.org.uk, and for most people it goes smoothly. For some, it does not.
Maybe you are now so groggy that you cannot drive or think straight. Or, the withdrawal symptoms you hoped to leave behind have come back, and the diazepam does not seem to be doing anything at all. Some people feel both at once and cannot tell which is which.
Push on, adjust, or go back? Dr. Leeds sees all three as legitimate, decided with the prescriber, and this article lays out the options in the order he usually considers them.
Why is the switch to Valium usually worth trying in the first place?
Klonopin leaves the body faster than diazepam, so its blood level rises and falls between doses. Professor Ashton wrote of clonazepam that “It is difficult with this drug to achieve a smooth, slow fall in blood concentration,” which is why many people on Klonopin feel withdrawal symptoms between doses long before any taper begins.
Diazepam lingers for days, each dose overlapping the last, and it allows very small steps. In Dr. Leeds’ experience, patients who are able to taper with diazepam tend to have a more comfortable taper and function better day to day, which is why the Valium substitution method is his usual starting point.
Yet, usual is not universal. Professor Ashton herself noted that “Some people, however, appear to have particular difficulty in switching from Klonopin to diazepam.” The method is sound. It is not a law.
First, work out which way the switch went wrong.
A crossover can fail in two opposite directions, and Professor Ashton described both. A person moved onto the full table equivalent of diazepam “is liable to become extremely sleepy, but if he is switched suddenly onto a much smaller dose of diazepam, he will probably get withdrawal symptoms.” Which of the two is happening to you decides everything that follows.
Too much diazepam looks like drowsiness, grogginess, unsteadiness, and slowed thinking, and it often gets worse over the first week or two rather than better, because, as the Maudsley Deprescribing Guidelines (chapter 3, p. 404) put it, “Diazepam accumulates upon multiple dosing.” Some people clear it far more slowly than others, depending on genetics, other medicines, liver function, and age, and there is no simple way to know in advance who they are.
Too little diazepam looks like the familiar Klonopin withdrawal symptoms returning as the clonazepam leaves the body. Unfortunately, the two can overlap in the same person, which is where the confusion comes from.
In Dr. Leeds’ practice, a diazepam blood level and a complete list of everything else the patient takes often settle the question. One shows whether diazepam is piling up, and the other shows what might be slowing it down.
The first option is to hold the dose and let the diazepam settle.
An analogy that may help, while not a perfect one, is an old house heated by heavy iron radiators. Turn the thermostat up a notch, and the rooms keep warming for hours after the dial has stopped moving, because the iron holds and releases its heat slowly.
Diazepam behaves like those radiators. After any change in dose, the blood level drifts for a week or two or more before it settles, so a person who adjusts every few days is judging a level that has not finished moving. The Maudsley Deprescribing Guidelines (chapter 3, p. 335) note that “A period of stabilisation (e.g. 2 weeks or longer) on the new drug may be required before commencing a taper.”
So, the lesson of the radiators is plain. Change one thing, then wait long enough to see what it did. For many people whose symptoms are uncomfortable but not alarming, holding while the level evens out is the whole answer, and Dr. Leeds often makes it the first step.
The second option is to adjust the diazepam, one change at a time.
If the hold has done its work and you are still too sedated, the diazepam can come down. If you are still in withdrawal, it can go up a little. One change at a time, followed by another wait, because a cut that goes too far simply trades sedation for diazepam withdrawal.
Why would the table be wrong in the first place? Because conversion tables are estimates. The Maudsley Deprescribing Guidelines (chapter 3, p. 335) say that equivalencies “can only be seen as rough estimates, and there can be significant inter-individual differences,” and Professor Ashton wrote that her own figures “are only approximate and differ between individuals.” The usual table treats Klonopin as roughly twenty times as potent as Valium, a ratio of about 1:20, so a small misjudgment on the Klonopin side becomes a large one on the Valium side.
A table has never met the person taking the tablets. Professor Ashton allowed that “the substitution may not always need to be complete,” and the same chapter of the Maudsley Deprescribing Guidelines instructs that “Patient-reported symptoms should therefore be prioritised and adjustments should be made so as to minimise withdrawal symptoms.” How you feel is the data.
The third option is to slow the crossover down and take both drugs for a while.
Some switches that fail were made all at once, the whole Klonopin dose swapped for diazepam on a single day. Professor Ashton’s own schedules never did that. They exchange the two drugs over weeks, and she explained why: “Making the changeover one dose (or part of dose) at a time avoids this difficulty and also helps to find the equivalent dosage for that individual.”
A sudden switch can be turned back into a stepwise one, with some of the Klonopin returning, some of the diazepam staying, and the exchange made one dose at a time as the prescriber decides. Clonazepam levels settle within days, so it can serve as the steadier partner while the diazepam, with its slow rise, finds its own level.
Is it safe to be on two benzodiazepines at once? Under supervision, for a defined period, this is how the Ashton crossover was designed to work. What is not safe is doing it alone.
The fourth option is to go back to Klonopin and taper from it directly.
Some people cannot tolerate diazepam, and that may not be discovered right away. When it becomes clear, Dr. Leeds’ view is that it makes sense to go backwards, return to the original benzodiazepine, and taper from there. The switch back is itself made gradually, dose by dose, under the prescriber’s eye.
It is fair to say that Professor Ashton would not have reached for this first. On dose direction she was firm: “However, it is important in withdrawal always to go forwards. If you reach a difficult point, you can stop there for a few weeks if necessary, but you should try to avoid going backwards and increasing your dosage again.” While she favored the diazepam switch, she also described tapering straight from Klonopin with tiny doses prepared by a compounding pharmacist, a route she said “can be troublesome and is not recommended for general use.”
Troublesome is not the same as wrong. In the United States there is no manufactured clonazepam oral solution, so the small, shrinking steps a direct Klonopin taper needs come from a compounded liquid or compounded doses made to order, and Dr. Leeds works with compounding pharmacies to prepare them when a direct taper is the better route.
Your own history on clonazepam counts as information too. If you were steady on it for years before the switch, that is a known quantity, and the Maudsley Deprescribing Guidelines (chapter 3, p. 335) make room for it: “Other patients may find switching difficult or prefer to taper from the original, familiar drug.” Familiar is not a small thing.
Going back is not failure.
Returning to Klonopin can sound like giving up, especially to a family member who has read that Valium is “the right way.” It is not giving up. It is choosing the taper your body can tolerate over loyalty to a method.
A person who took Klonopin as prescribed and developed physical dependence has a medical condition caused by the medication, and dependence is not addiction. So, nothing is proven by suffering through a diazepam that does not suit you, and nothing is lost by changing course.
If you were told the sleepiness would pass and it did not, you may be wary of the next reassurance, and that wariness is reasonable. Informed consent for any of these options means hearing the risks first, hearing the alternatives, including going back, knowing the exit plan, and keeping the right to decline. The taper is patient directed.
What should you bring to the prescriber?
Three things make the conversation short and useful. First, dated notes of your symptoms, with the time of day, so the pattern can be seen against the dose schedule. Second, a full list of every medicine, supplement, and over-the-counter product you take, since several can slow the clearance of diazepam. Third, a willingness to have a diazepam blood level drawn if the prescriber wants one.
Whatever is decided, nothing stops abruptly. The U.S. Food and Drug Administration’s 2020 update to the benzodiazepine boxed warning recognizes withdrawal reactions, including protracted ones, after abrupt discontinuation or rapid dose reduction, and a person who is sedated on diazepam is still physically dependent on a benzodiazepine.
One line belongs here, outside the options. Heavy sedation, confusion, slowed breathing, or being unable to stay awake, especially if alcohol is involved, is an emergency, and the right response is to call 911, not to wait for the next appointment.
Questions people ask when a Klonopin to Valium switch goes wrong.
Can someone go back to Klonopin after switching to Valium?
Yes. It is done gradually, in reverse of the crossover, with the prescriber setting each step, and the taper then continues from clonazepam using small compounded doses. Dr. Leeds regards it as a sound choice for a person who cannot tolerate diazepam.
Why would Valium make someone sleepier two weeks after the switch?
Because diazepam accumulates. Each dose overlaps the last, and the blood level keeps climbing for a week or two before it levels off, so a dose that felt fine on the first day can feel like too much later. People who clear it slowly feel this most.
Can Klonopin be tapered without switching to Valium?
It can. Professor Ashton described tapering straight from Klonopin with specially prepared small doses and called the approach troublesome and not for general use, and in the United States those doses must be compounded. With that arrangement in place, a direct Klonopin taper is a reasonable route.
How Dr. Leeds works through a crossover that has gone wrong.
The four options above are the shape of a typical conversation in his practice. He meets with patients weekly by video, often for up to an hour, and is reachable by text between visits, which matters most in exactly these weeks, when a dose has just changed and the diazepam has not yet settled. Each hold, adjustment, overlap, or return to Klonopin is decided together, and nothing is forced.
If your switch from Klonopin to Valium is not working, you do not have to guess. Contact the office today to talk through the options. He prescribes for patients located in Florida and sees them by telemedicine throughout the state.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
