II. Mechanism

  1. Azapirone modulates Serotonin transmission

III. Dosing

  1. Start: 7.5 mg PO bid (or 5 mg PO tid)
  2. Effective dose: 20 to 30 mg per day
  3. Maximum: 60 mg per day

IV. Indications

  1. Anxiety Disorders
    1. Generalized Anxiety Disorder
    2. Chronic Anxiety Disorder
    3. Anxiety in the elderly
  2. Aggression in developmentally disabled
  3. Agitated Dementia
  4. Emotional behavioral problems in brain injury
  5. Geriatric Depression
  6. Adjunctive use with SSRI in Major Depression
    1. Mixed anxiety and depression
    2. Enhance Major Depression response to SSRI
    3. Antidepressant Induced Sexual Dysfunction
  7. Alcohol Withdrawal
    1. Reduces anxiety of "needing" a drink
  8. Obsessive Compulsive depression
    1. Use Buspar with Prozac
  9. Decreases Neuroleptic adverse effects
    1. Reduces Tardive Dyskinesia
    2. Reduces Akathisia
    3. Reduces Parkinsonism

V. Advantages compared with Benzodiazepines

  1. Non-addictive
  2. Less Sedation
  3. No associated memory Impairment
  4. No significant withdrawal syndrome
  5. Minimal Overdose potential
  6. No Anticholinergic Toxicity
  7. Well tolerated by elderly patients

VI. Disadvantages compared with Benzodiazepine

  1. Slow onset of action (takes 2-4 weeks until effect)
  2. Not useful in Panic Attacks
  3. No Sedative effect
  4. Requires repeat dosing 2-3 times per day

VII. Precautions

  1. Avoid use in pregnancy and Lactation
  2. Avoid in hepatic or renal Impairment

VIII. Adverse Effects

  1. Dizziness or light headedness
    1. Onset within 30 minutes of ingestion
    2. Duration less than 20 minutes
  2. Mild Headache
  3. Nausea
  4. Nervousness
  5. Insomnia

IX. Drug Interactions

  1. MAO inhibitors
  2. Haloperidol (Haldol)
  3. Cyclosporine (Sandimmune)
  4. Disulfiram (Antabuse)
  5. Erythromycin and Itraconazole suppresses p450
    1. Results in Buspirone levels 5-13 times normal

X. Protocol to convert from Benzodiazepine to Buspirone

  1. Convert short-acting Benzodiazepine to long-acting
    1. Example: Alprazolam to Clonazepam
  2. Start Buspirone at above doses
  3. Taper long-acting Benzodiazepine over 60 to 90 days

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Cost: Medications

Buspirone (on 6/18/2017 at Walmart.com)
Buspirone 10mg #60 tablets for $4.00 $0.07 each
Buspirone 10mg #180 tablets for $10.00 $0.06 each
Buspirone 5mg #60 tablets for $4.00 $0.07 each
Buspirone 5mg #180 tablets for $10.00 $0.06 each
buspirone (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
BUSPIRONE HCL 10 MG TABLET Generic $0.06 each
BUSPIRONE HCL 15 MG TABLET Generic $0.08 each
BUSPIRONE HCL 30 MG TABLET Generic $0.42 each
BUSPIRONE HCL 5 MG TABLET Generic $0.04 each
BUSPIRONE HCL 7.5 MG TABLET Generic $0.45 each