Buspirone Toxicity

Aka: Buspirone Toxicity, Buspirone Overdose, Burpirone Poisoning

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II. Findings

  1. Cardiovascular
    1. Hypotension
    2. Bradycardia
  2. Neurologic
    1. Dizziness
    2. Sedation
    3. Seizures
    4. Hyperreflexia
    5. Altered Movement
      1. Dyskinesia
      2. Akathisia
      3. Dystonia
  3. Miscellaneous
    1. Nausea or Vomiting
    2. Miosis

III. Pharmacokinetics

  1. See Buspirone
  2. Doses up to 375 mg are typically tolerated without significant adverse effects

IV. Labs

  1. See Unknown Ingestion
  2. Electrocardiogram (if severe signs, e.g. Hypotension, Bradycardia)

V. Management

  1. See Unknown Ingestion (for general approach to ingestions)
  2. Activated Charcoal in first hour of ingestion (if not otherwise contraindicated)
  3. Hypotension
    1. Intravenous Fluid bolus
    2. Vasopressors (e.g. norephinephrine) in fluid refractory cases
  4. Seizures
    1. See Status Epilepticus
    2. Benzodiazepines
    3. Levetiracetam (Keppra)
  5. Serotonin Syndrome
    1. See Serotonin Syndrome
    2. Benzodiazepines
    3. Cyproheptadine (Periactin)
  6. Disposition
    1. May discharge if asymptomatic at 4 to 6 hours after ingestion
    2. Observe or admit patients who are symptomatic, have altered Vital Signs or an abnormal EKG

VI. Resources

  1. Buspirone Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0eefdd8d-7745-47ae-a204-f35687f3db11

VII. References

  1. Tomaszewski (2023) Crit Dec Emerg Med 37(5): 32
  2. Wilson (2023) Buspirone, StatPearls, Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK531477/

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