Buspirone

Aka: Buspirone, Buspar

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II. 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

III. Mechanism

  1. Buspirone is an azapirone that modulates Serotonin transmission
  2. Partial 5-HT1A Serotonin receptor Agonist
    1. Risk of Serotonin Syndrome
  3. Partial D2 Dopamine Receptor
    1. Risk of Akathisia

IV. 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

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
  8. Does not affect GABA levels

VI. Disadvantages (compared with Benzodiazepines)

  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. Pharmacokinetics

  1. Low oral Bioavailability (<5%)
  2. Half-Life: 2 to 3 hours
  3. Peaks: 0.9 to 1.5 hours after ingestion

X. Drug Interactions

  1. Metabolized by CYP3A4
  2. MAO Inhibitors
  3. Haloperidol (Haldol)
  4. Cyclosporine (Sandimmune)
  5. Disulfiram (Antabuse)
  6. Erythromycin and Itraconazole suppresses p450
    1. Results in Buspirone levels 5-13 times normal

XI. Management: 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

XII. Resources

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

XIII. References

  1. Wilson (2023) Buspirone, StatPearls, Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK531477/
  2. (1997) Clin Pharmacol Ther, 32:348 [PubMed]
  3. Cadieux (1996) Am Fam Physician 53(7): 2349-53 [PubMed]

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Related Studies

Cost: Medications

buspirone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BUSPIRONE HCL 10 MG TABLET Generic $0.04 each
BUSPIRONE HCL 15 MG TABLET Generic $0.05 each
BUSPIRONE HCL 30 MG TABLET Generic $0.17 each
BUSPIRONE HCL 5 MG TABLET Generic $0.03 each
BUSPIRONE HCL 7.5 MG TABLET Generic $0.16 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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