What is the recommended dosing frequency for Buspirone (buspirone), a medication used to treat anxiety, should it be taken daily or as needed?

From the Guidelines

Buspirone should be taken daily on a regular schedule, not as needed, as it typically takes 2 to 4 weeks to become effective and works by gradually adjusting brain chemistry over time, specifically affecting serotonin receptors 1.

Key Points to Consider

• The usual starting dose is 5 mg twice daily, with a maximum of 20 mg three times daily, as indicated in the guidelines for managing behavior and mood disorders 1.
• Missing doses can disrupt the steady blood levels needed for effectiveness, which is crucial for achieving the full therapeutic effect of buspirone.
• It's essential to take buspirone at approximately the same times each day to maintain consistent blood levels and minimize potential side effects.
• Patients should not stop taking buspirone suddenly without consulting their healthcare provider, as this could lead to discontinuation symptoms.
• If side effects occur, such as dizziness, headache, or nausea, these often diminish over time with continued use, allowing patients to benefit from the anxiolytic effects of buspirone while minimizing its drawbacks.

From the FDA Drug Label

The recommended initial dose is 15 mg daily (7.5 mg b.i.d.) To achieve an optimal therapeutic response, at intervals of 2 to 3 days the dosage may be increased 5 mg per day, as needed.

The dosage instructions indicate that buspirone should be taken daily, with the option to increase the dose as needed. The initial dose is 15 mg daily, and it can be increased by 5 mg per day at intervals of 2 to 3 days. Daily administration is the recommended approach, rather than taking it as needed. 2

From the Research

Dosage and Administration

• Buspirone is typically given at a dosage of 15 mg/day 3
• The drug can be taken daily, as its pharmacokinetics are linear over the dose range 10 to 40 mg 3
• Administration with food increases the peak plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC) of buspirone 2-fold 3

Efficacy and Safety

• Buspirone is effective for treating generalized anxiety disorder, with efficacy comparable to benzodiazepines 4, 5, 6
• The drug has a slower and more gradual onset of anxiety relief, but is balanced by increased safety and lack of dependency-producing aspects 4
• Buspirone causes fewer side effects than lorazepam and is not different from placebo in this respect 6

Treatment Regimen

• Buspirone can be used as a daily treatment for generalized anxiety disorder, with a typical dosage of 15 mg/day 3, 6
• The drug may not be suitable for patients who demand immediate gratification or relief, as it has a slower onset of action 4
• Buspirone can be considered a treatment option for managing irritability, agitation, and aggression in older adult patients with dementia, as well as in pediatric patients 7

Special Considerations

• Buspirone is not recommended for routine treatment of panic disorder, as studies have been inconclusive 4
• The drug may be useful for treating coexisting anxiety and depression, and for managing adverse sexual effects 7
• Buspirone should be used with caution in patients with renal or hepatic impairment, as its pharmacokinetics may be affected 3