Buspirone Explained: Usage, Dosage, And Side Effects

Buspirone is a prescription medication to treat anxiety disorders and to provide relief from symptoms (via MedlinePlus). It belongs to a class of medications called anxiolytics, or anti-anxiety drugs, which also includes benzodiazepines, the anticonvulsant pregabalin, and the antihistamine hydroxyzine (via RxList). It's not clear exactly how buspirone works, but according to the National Institutes of Health (NIH), some researchers believe its effectiveness is due to its ability to regulate serotonin, a hormone and neurotransmitter that plays an important role in mood (via the Cleveland Clinic). Abnormalities in the levels of serotonin in the brain are thought to contribute to the development of anxiety disorders (via PLoS Computational Biology). Buspirone is the name of the generic medication. It is also available under the brand names BuSpar, Buspirex, Bustab, and LinBuspirone (via RxList). This medication requires a prescription from a medical professional and active monitoring due to the potential for toxicity and negative interactions with other prescription medications. 

According to the Anxiety & Depression Association of America, anxiety disorders are the most common form of mental illness in the United States, affecting almost 20% of American adults each year. There are several different categories of anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, social anxiety, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD). Buspirone is primarily used to treat GAD, which is characterized by excessive worry about a variety of events and activities (via the NIH and the National Institutes of Mental Health). 

People with GAD find it hard to control their worrying, which can pose a challenge in their personal and professional lives. Symptoms of GAD can include a keyed-up or restless feeling; impaired concentration; fatigue; irritability; aches and pains that may be felt in different places throughout the body; and trouble sleeping. It's important to note that GAD is different from the stress that many people feel as a part of normal daily life; people with GAD experience a persistent feeling of fear and dread that may not be related to a specific life situation. 

Though buspirone is chiefly used to treat generalized anxiety disorder (GAD), it may also be used as an antidepressant in patients who do not respond to or cannot tolerate the side effects of selective serotonin reuptake inhibitors (SRIs), and it may be used in tandem with SSRIs to reduce the sexual side effects commonly associated with those medications (via the NIH). Buspirone may also be used as an off-label clinical treatment for unipolar depression, or major depressive disorder (MDD). Some research shows that buspirone combined with the hormone melatonin may successfully treat MDD, although the FDA has not approved it for this usage. Buspirone has also been used off-label to treat several other conditions such as substance abuse, PTSD, bruxism, tardive dyskinesia, and Parkinson's disease, but its efficacy has not been proven (via NIH and Parkinsonism & Related Disorders). Small trials have also showed evidence that buspirone could be used as a treatment for heart failure and indigestion, but more research is needed to confirm these findings (via NIH).

The FDA approved buspirone for the treatment of GAD in 1986 due to a wealth scientific research proving its efficacy (via Drugbank Online). Although benzodiazepines were the most widely used the go-to prescription drugs for GAD in the 80s, buspirone's popularity increased because studies showed it was equally effective and had fewer side effects (via UW Medicine and the Journal of Clinical Psychopharmacology). The main difference is that it takes buspirone longer to take effect. Anxiety disorders and depressive disorders often coexist, and buspirone has also been shown to be an effective treatment for both. In a 1992 meta-analysis in Neuropsychobiology, buspirone was shown to be significantly more effective at treating individuals with co-existing GAD and depression compared to a placebo. 

As for its off-label uses, more research still needs to be done. According to a 2015 review in the Journal of Psychosocial Nursing and Mental Health Services, most research on buspirone for substance abuse disorders had disappointing results, although one study showed positive results when it was used for heroin detoxification. A 2020 study showed that buspirone was effective for easing anxiety in patients with Parkinson's disease, however there were roadblocks posed by side effects and tolerability that led researchers to conclude that a large-scale efficacy trial was not warranted (Parkinsonism & Related Disorders). 

Buspirone may cause side effects which you should discuss with your doctor before you begin taking the medication. These may include dizziness, headache, excitement,  nervousness, fatigue, trouble falling asleep or staying asleep, feeling angry or hostile, weakness, and numbness (via MedlinePlus). These are not likely to be serious, and some side effects may be temporary and go away after your body adjusts to the medication (via British Heart Foundation). However, you should still tell your doctor any side effects you may experience, especially if they persist. 

Buspirone can also have serious side effects. If you experience any of the following, you should notify your doctor immediately: symptoms of an allergic reactions such as rash, hives, itching, swelling of the mouth, nose, throat, face, eyes, tongue, or lips; blurred vision; irregular or accelerated heartbeat; shaking or twitching; lightheadedness; agitation; fever; sweating; hallucinations; impaired coordination; confusion; flushing; or gastrointestinal problems such as nausea, vomiting, or diarrhea (per MedlinePlus).

Buspirone may interact with medications you take for other health conditions. According to the Mayo Clinic, it's not recommended to take buspirone with the following medications due to the potential of severe interactions: isocarboxazid, linezolid, phenelzine, procarbazine, selegiline transdermal, tranylcypromine. Several of these — isocarboxazid, phenelzine, selegiline, and tranylcypromine — are monoamine oxidase inhibitors (MAOIs) that can increase the risk of a dangerous condition called serotonin syndrome when taken together with buspirone (via the Cleveland Clinic and Mental Health Clinician). Linezolid is an antibiotic that you may take if you have pneumonia or other bacterial conditions, according to MedlinePlus. Procarbazine is a drug used in chemotherapy, specifically to treat Hodgkin's lymphoma. 

Buspirone may have central nervous system (CNS) depressant effects (via Integrative Psychiatry). Therefore, the side effects of other CNS depressant medications such as antihistamines or other allergy and cold medicines, sleeping medications, prescription pain relief medications, sedatives, tranquilizers, narcotics, barbiturates, seizure medications, muscle relaxants, and anesthetics can be compounded when combined with buspirone. These effects include fatigue, lack of coordination, poor concentration, low blood pressure, and slow breathing (via the NIH).

Several other drugs, as well as plant-based supplements like ginkgo or St. John's wort, can also cause particular side effects if taken alongside buspirone (via Mayo Clinic). Though your doctor may decide you can safely use both buspirone and another drug or supplement, be sure to inform your physician about anything you take regularly so they can make an informed decision about which drugs to prescribe, and at what dosage.

You should take buspirone as directed by your doctor and according to the instructions on your unique prescription. Although there are standard dosages of the medication, your prescribed amount and the frequency with which you take it will depend on your specific health condition, your physiology, and any other medications you are taking (via The Checkup). Taking less than the prescribed dose may make buspirone ineffective, and taking too much can increase the risk of side effects and be potentially dangerous (via Banner Health). 

According to the Mayo Clinic, typical dosages for buspirone start at 7.5 mg twice a day. Dosage may increase to as much as 60 mg per day at your doctor's discretion. You can take the medication either with or without food, but it's best to choose one or the other and be consistent. You should avoid eating grapefruit and drinking grapefruit juice while taking buspirone because it interferes with the way your body metabolizes the drug (via the FDA). If you miss a dose, take it as soon as you remember it. However, you can skip a dose if it's nearly time for your next one, as you should not take two doses at the same time.

You should not drink alcohol while taking buspirone (via the Mayo Clinic). You should also not stop taking buspirone without consulting your doctor first, as going cold turkey on the medication could cause withdrawal. The effects of withdrawal can include mood and cognitive issues (anxiety, confusion), stomach upset, sleep disturbances, sweating, cramping, and excessive fatigue among other things. Your doctor may recommend tapering off your dosage over a period of time so as to avoid these effects. 

If you believe you may have taken too much buspirone, you should contact emergency services. Overdose symptoms can include feeling dizzy or lightheaded, exhaustion, losing consciousness, an upset tummy, and dilated pupils. 

The liver and kidneys are crucial to how buspirone is broken down in the body and subsequently passed out through waste (via Drugs.com). Therefore, its use in people with severe liver or kidney problems is contraindicated due to the potential of a buildup of medication in the body.

Compared to benzodiazepines, buspirone has a lower risk of addition and abuse (via California Highlands Vistas Addiction Treatment). Indeed, a 1982 study in the Journal of Clinical Psychiatry found that buspirone posed less risk of abuse and addiction than the benzodiazepine diazepam. But there is still a risk. Because it has sedating effects, people with substance abuse disorders may still use buspirone to get high. Buspirone abuse effects may include hallucinations, euphoric feelings, stomach upset, poor coordination, and fatigue. Overdosing on buspirone is also a risk, and symptoms include blurry vision, dizziness, drowsiness, and nausea or vomiting.

If an individual does develop an addiction to buspirone, they should work with their healthcare team to plan an offramp from the medication that minimizes the health risks of withdrawal (via California Highlands Vistas Addiction Treatment). Weaning off the medication under a doctor's supervision followed up with behavioral therapy to address the root of the addiction is the typical course of treatment for buspirone addiction.

If you or anyone you know needs help with addiction issues, help is available. Visit the Substance Abuse and Mental Health Services Administration website or contact SAMHSA's National Helpline at 1-800-662-HELP (4357).

If buspirone doesn't work or you can't tolerate the symptoms, there several other medications your doctor may prescribe to treat your condition. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitor (SNRIs) are often used to treat anxiety (via the Mayo Clinic). Some examples of these medications include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR), and paroxetine (Paxil, Pexeva). There may be other antidepressants your doctor recommends based on your symptoms. These medications may be more or less effective and have more or fewer side effects, but it depends on the individual. 

Benzodiazepines are also used to treat anxiety. However, according to the Mayo Clinic, they are typically only used for short-term treatment of acute anxiety symptoms. Buspirone has advantages over benzodiazepines because it is less likely to cause sedation or memory problems, and is far less likely to provoke an addiction (per Buspirone).