Buspirone
Buspirone (Buspar)
Generic Name
Buspirone (Buspar)
Indications
Generalized anxiety disorder (GAD). Not approved for panic disorder.
Monitoring
- Baseline liver function tests; monitor if ALT/AST rises >3× ULN.
- Blood pressure in patients susceptible to orthostatic hypotension.
- No routine lab monitoring for mild therapy.
Clinical Pearls
- Pregnancy Category C: limited human data; use only if benefits outweigh risks.
- Breastfeeding: buspirone is excreted into milk; not recommended unless no alternatives.
Clinical Notes
Buspirone (buspirone) – anxiolytic (5-HT1A partial agonist)
| Category | Key Points |
|---|---|
| Indication | Generalized anxiety disorder |
| Mechanism of Action | Partial agonist at serotonin 5-HT1A receptors; no activity at GABA-benzodiazepine receptor complex |
| Pharmacokinetics | Low bioavailability (4%) due to first-pass metabolism; CYP3A4 substrate; half-life 2-3h |
| Dosing (adult) | 7.5 mg BID initially; increase gradually; usual 20-30 mg/day divided; max 60 mg/day |
| Key Contraindications | MAOIs; severe hepatic or renal impairment |
| Common Adverse Effects | Dizziness, nausea, headache, nervousness, lightheadedness (generally well tolerated) |
| Drug Interactions | MAOIs; CYP3A4 inhibitors/inducers; grapefruit juice |
| Monitoring | Anxiety response, delayed onset of action expected |
| Other Considerations | 2-4 week onset; no sedation, dependence, or withdrawal; does not potentiate CNS depressants |
| Reference | FDA prescribing information |
Quick-reference tip: Non-addictive alternative to benzodiazepines – requires 2-4 weeks for effect; scheduled dosing only
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