1. Introduction
Buspirone is a non-benzodiazepine anxiolytic used primarily for generalised anxiety disorder (GAD). It works as a partial agonist of serotonin (5-HT1A) receptors, helping to reduce anxiety without causing sedation, dependence, or cognitive impairment seen with benzodiazepines.
2. Indications
- Generalised Anxiety Disorder (GAD)
- Adjunctive Treatment for Depression (Off-label use, particularly for SSRI-induced sexual dysfunction)
3. Dosage
Adults (Generalised Anxiety Disorder):
- Initial dose: 5 mg twice or three times daily
- Maintenance dose: 20–30 mg/day (divided into 2–3 doses)
- Max dose: 60 mg/day
Elderly:
- Start at lower doses (5 mg twice daily) and titrate gradually.
Renal Impairment:
- Mild-moderate: No adjustment needed.
- Severe impairment: Use with caution—reduce dose and monitor.
Hepatic Impairment:
- Mild-moderate: Reduce dose by 50%.
- Severe liver impairment: Avoid use due to risk of drug accumulation.
4. Administration
- Take consistently either with or without food (food affects absorption rate).
- Avoid grapefruit juice (increases drug levels).
- Do not take with alcohol—may reduce effectiveness.
5. Forms Available
- Tablets: 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg
6. Side Effects
6.1 Common Side Effects:
- Dizziness
- Nausea
- Headache
- Nervousness
- Lightheadedness
6.2 Less Common Side Effects:
- Fatigue
- Sweating
- Blurred vision
6.3 Rare but Serious Side Effects:
- Serotonin Syndrome (when combined with SSRIs or MAOIs)
- Movement disorders (rare extrapyramidal symptoms like tremors, muscle spasms)
- Increased blood pressure (if combined with MAOIs)
7. Warnings
- Not for Acute Anxiety Relief:
- Takes 2–4 weeks to show full effects—not effective for acute panic attacks.
- Risk of Serotonin Syndrome:
- Avoid combining with SSRIs, SNRIs, MAOIs, or triptans without medical supervision.
- Caution in Bipolar Disorder:
- May trigger mania in patients with undiagnosed bipolar disorder.
- No Withdrawal Symptoms:
- Unlike benzodiazepines, buspirone does not cause dependence or withdrawal.
8. Precautions
- Avoid alcohol—can reduce effectiveness and increase dizziness.
- Not recommended for panic disorder (may worsen symptoms).
- Use with caution in patients with a history of seizures.
9. Interactions
- MAOIs (e.g., phenelzine, selegiline): Contraindicated—risk of hypertensive crisis.
- SSRIs/SNRIs (e.g., fluoxetine, venlafaxine): Increased risk of serotonin syndrome.
- CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin): Increase buspirone levels—reduce dose.
- CYP3A4 Inducers (e.g., rifampin, carbamazepine): Decrease buspirone levels—may reduce effectiveness.
- Grapefruit juice: Increases buspirone concentration—avoid drinking it.
10. Monitoring Parameters
- Anxiety symptom improvement (after 2–4 weeks)
- Dizziness or drowsiness (especially in elderly patients)
- Blood pressure (if used with MAOIs or other serotonergic drugs)
11. Use in Children
- Not FDA-approved for children but sometimes used off-label for anxiety in adolescents.
12. Use in Pregnancy
- Category B:
- Considered safer than benzodiazepines in pregnancy but should be used only if clearly needed.
13. Use in Elderly
- Start at lower doses (5 mg twice daily) due to increased sensitivity to dizziness.
14. Use in Kidney Disease
- No major dose adjustment needed but use cautiously in severe impairment.
15. Use in Liver Disease
- Mild-moderate impairment: Reduce dose by 50%.
- Severe impairment: Avoid use.
16. Patient Counselling Points
- Takes 2–4 weeks for full effect—not for immediate anxiety relief.
- Avoid alcohol and grapefruit juice—can affect drug levels.
- Does not cause dependence or withdrawal—safe for long-term use.
- Take at the same time daily for best results.
- If dizziness occurs, take it at bedtime or lower the dose.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Buspar | Bristol-Myers Squibb | 5 mg, 10 mg, 15 mg, 30 mg Tablets | $100 (30 tabs) |
Generic Buspirone | Various | 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg Tablets | $30 (30 tabs) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Buspirone used for?
It is used to treat generalised anxiety disorder (GAD).
2. How does Buspirone work?
It is a partial serotonin agonist (5-HT1A), reducing anxiety without sedation.
3. How long does it take for Buspirone to work?
2–4 weeks—not useful for immediate anxiety relief.
4. Can Buspirone be used for panic attacks?
No, it is not effective for panic disorder or acute anxiety episodes.
5. Can Buspirone be taken with SSRIs?
Yes, but monitor for serotonin syndrome.
6. Does Buspirone cause weight gain?
No, it is weight-neutral.
7. Can I take Buspirone with alcohol?
No, alcohol may reduce effectiveness.
8. Can I take Buspirone long-term?
Yes, it is safe for long-term use without addiction risk.
9. Can Buspirone be stopped suddenly?
Yes, but gradual tapering is preferred for comfort.
10. Does Buspirone cause drowsiness?
It does not cause sedation but may cause mild dizziness.
11. Can Buspirone be used for depression?
Yes, as an adjunct for SSRI-induced sexual dysfunction.
12. Can I take Buspirone at bedtime?
Yes, taking it at night may reduce dizziness.
13. Can Buspirone cause withdrawal symptoms?
No, it does not cause dependence.
14. Does Buspirone increase blood pressure?
Only when combined with MAOIs.
15. How should Buspirone be stored?
Store at room temperature, away from moisture.