Section 3.3.2

Buspirone

General Description

Buspirone (Buspar) is a novel azaspirone anxiolytic drug that offers a distinct alternative to treatment of anxiety with benzodiazepines. Buspirone is an exception to the generalization that anxiolytics are also sedatives and hypnotic. In contrast to benzodiazepines, buspirone carries a low potential for abuse and is not associated with withdrawal symptoms, sedation or cognitive impairment.

Indications for Medication

The primary indication for buspirone treatment is anxiety, particularly generalized anxiety disorder. Adjunctive buspirone has also been shown to be effective for reducing the anxiety component in other psychiatric disorders. However, buspirone has not been shown to be effective in panic disorders.

Literature reports suggest that buspirone is effective in the treatment and control of anxiety and aggression in developmentally disabled persons. Buspirone may be useful in treating emotional and behavioral problems in the brain injured and elderly patients.

Buspirone augmentation may lead to symptomatic improvement in patients with depression or obsessive compulsive disorder who are taking fluoxetine (Prozac). Buspirone augmentation may also lead to symptomatic improvement in depressed patients who are taking other antidepressants.

The beneficial effects of benzodiazepines are felt the same day they are started; the full clinical response often takes just several days. Buspirone has no immediate effects and the clinical response may take two to four weeks, someTahoma even longer.

Clinical Guidelines

Buspirone treatment is usually initiated at 5mg two or three Tahoma a day. An effective dose range for buspirone may vary from 15-60mg a day. The maximum dose of buspirone is 60mg a day.

Buspirone may be as useful as the benzodiazepines in the treatment of anxiety in patients who have not received benzodiazepines in the past. However, buspirone does not seem to be as effective in patients who have received benzodiazepines in the past.

The most common clinical problem for buspirone is how to start giving buspirone to a patient who is currently taking a benzodiazepine. There are two possibilities. First, it is possible to start buspirone and to titrate buspirone towards an effective dose as the benzodiazepine is being gradually withdrawn. Second, it is possible to start buspirone, bringing the patient to a full therapeutic buspirone dose for two or three weeks, while the patient is still receiving benzodiazepine. When the titration is fully completed and stabilized, the benzodiazepine can then be withdrawn.

Adverse Effects

The most common adverse effects of buspirone are headaches, nausea, dizziness, nervousness, dry mouth, diarrhea and insomnia. No sedation is associated with buspirone. Some patients report a minor feeling of restlessness, although that symptom may reflect incomplete treatment of the primary anxiety disorder.

Buspirone should be used with caution in patients with hepatic and/or renal disease. Buspirone should also be used with caution in pregnant women and in nursing mothers, although it is not known whether buspirone passes into the breast milk.

Drug-Drug Interactions

Buspirone should not be used with the monamine oxidase inhibitors unless a two-week washout period has occurred.

Literature reports indicate that the co-administration of buspirone and haloperidol causes a possible increase in the blood concentrations of haloperidol. The effect Buspirone has on neuroleptic blood levels should be kept in mind when buspirone is added to a neuroleptic treatment regimen.

The consent form for this medication is "Anti-anxiety Medication (buspirone)."