Buspar (buspirone) is a non-benzodiazepine anxiolytic agent indicated for the management of anxiety disorders. It offers a distinct pharmacological profile, primarily acting as a partial agonist at serotonin 5-HT1A receptors, which differentiates it from traditional anti-anxiety medications. Unlike benzodiazepines, Buspar does not exhibit significant sedative, muscle relaxant, or anticonvulsant properties and carries a lower risk of dependence. It is particularly suitable for patients requiring long-term anxiety management without the cognitive impairment or tolerance development associated with other anxiolytics. Clinical use demonstrates efficacy in reducing symptoms of generalized anxiety, with therapeutic effects typically manifesting within 2–4 weeks of initiation.

Features

• Active ingredient: buspirone hydrochloride
• Pharmacological class: azapirone; serotonin receptor partial agonist
• Available formulations: oral tablets (5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg)
• Non-scheduled medication (not controlled substance)
• No active metabolites; eliminated primarily renal (29-63%) and fecal (18-38%)
• Half-life: 2–3 hours (requires multiple daily dosing)
• Protein binding: approximately 86%

Benefits

• Provides anxiolytic effects without significant sedation or cognitive impairment
• Minimal risk of pharmacological dependence or abuse potential compared to benzodiazepines
• Does not produce significant withdrawal syndrome upon discontinuation
• Suitable for long-term management of anxiety disorders
• Low incidence of weight gain or sexual dysfunction compared to SSRIs/SNRIs
• Can be used in patients with history of substance use disorders

Common use

Buspar is primarily indicated for the management of anxiety disorders, particularly generalized anxiety disorder (GAD). It may be used as either monotherapy or as an adjunct to other psychotropic medications. Off-label uses include augmentation therapy in depression, management of aggression in dementia, and treatment of sexual dysfunction secondary to SSRIs. The medication is particularly valuable for patients who cannot tolerate sedating effects of traditional anxiolytics or those with concerns about dependency.

Dosage and direction

Initial dosage: 7.5 mg twice daily, with increases of 5 mg per day every 2–3 days as needed Therapeutic range: 20–30 mg daily in divided doses (2–3 times daily) Maximum dosage: 60 mg daily (in divided doses) Administration: Should be taken consistently with regard to meals (always with food or always without food) Dosage adjustment required in hepatic impairment and in patients taking CYP3A4 inhibitors Not recommended in severe renal impairment (CrCl <30 mL/min)

Precautions

Use cautiously in patients with hepatic impairment (reduce dosage) May cause dizziness; caution patients about operating machinery or driving Avoid grapefruit juice (inhibits CYP3A4 metabolism) Not recommended during pregnancy unless clearly needed (Category B) Use in elderly patients may require dosage reduction due to decreased clearance Monitor for serotonin syndrome when used with other serotonergic agents Not intended for prn (as-needed) use; requires regular dosing for efficacy

Contraindications

Hypersensitivity to buspirone or any component of the formulation Concurrent use with MAO inhibitors (risk of hypertensive crisis) Severe hepatic impairment Concurrent use with strong CYP3A4 inhibitors in patients with hepatic impairment Not recommended in patients with severe renal impairment (CrCl <30 mL/min)

Possible side effect

Common (≥1%): dizziness (12%), nausea (8%), headache (6%), nervousness (5%) Less common: lightheadedness, excitement, insomnia, fatigue Rare: serotonin syndrome, extrapyramidal symptoms, akathisia Most side effects are dose-dependent and tend to diminish with continued therapy Generally better tolerated than benzodiazepines regarding sedation and cognitive effects

Drug interaction

MAO inhibitors: contraindicated (risk of hypertensive crisis) CYP3A4 inhibitors (ketoconazole, ritonavir, erythromycin): increase buspirone levels CYP3A4 inducers (rifampin, carbamazepine): decrease buspirone levels Other CNS depressants: additive sedation Serotonergic agents: increased risk of serotonin syndrome Haloperidol: may increase serum concentrations Trazodone: possible increased ALT Diltiazem, verapamil: may increase buspirone concentrations

Missed dose

If a dose is missed, take it as soon as remembered unless it is close to the next scheduled dose Do not double the dose to make up for a missed dose Maintain regular dosing schedule for optimal therapeutic effect If multiple doses are missed, contact healthcare provider before resuming therapy

Overdose

Symptoms: nausea, vomiting, dizziness, drowsiness, miosis, gastric distress No specific antidote exists; treatment is supportive Gastric lavage may be considered if presented early Monitor vital signs and provide symptomatic treatment Hemodialysis not effective due to high protein binding Contact poison control center for latest management recommendations

Storage

Store at controlled room temperature (20-25°C/68-77°F) Protect from light and moisture Keep in original container with tight closure Keep out of reach of children and pets Do not use after expiration date Do not transfer to other containers without proper labeling

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Buspar is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to medication may vary. Always consult with your healthcare provider for personalized medical advice, diagnosis, and treatment recommendations. Do not initiate, discontinue, or change dosage without medical supervision.

Reviews

Clinical studies demonstrate Buspar’s efficacy in anxiety management with favorable tolerability profile. Systematic reviews indicate comparable efficacy to benzodiazepines for generalized anxiety disorder with superior cognitive safety profile. Patient satisfaction surveys note appreciation for reduced sedation and absence of dependency concerns. Long-term studies support maintained efficacy over 6-12 months of treatment. Some patients report slower onset of action compared to benzodiazepines as a limitation. Overall, Buspar represents a valuable option in the anxiolytic armamentarium, particularly for patients requiring long-term therapy.