From the Research
For a 73-year-old patient with increased anxiety who is already on duloxetine 100 mg daily, trazodone 100 mg nightly, and bupropion XR 150 mg daily, I would recommend starting buspirone 5 mg twice daily, gradually increasing to 7.5-10 mg twice daily as tolerated after 1-2 weeks. This recommendation is based on the fact that buspirone has minimal drug interactions with the patient's current medications, doesn't cause sedation or cognitive impairment, and has no addiction potential 1.
Key Considerations
- The patient's current regimen already includes medications with some anxiolytic properties (duloxetine), so careful monitoring for serotonin syndrome is warranted when adding any new psychotropic medication.
- Given the patient's age, it's best to "start low and go slow" with dosing to minimize side effects like dizziness or headache.
- Buspirone typically takes 2-4 weeks for full effect, so the patient should be advised to be patient and not expect immediate results.
- Alternatively, if the anxiety is situational or mild, non-pharmacological approaches like cognitive behavioral therapy should be considered before adding another medication.
Supporting Evidence
- A study published in 2017 found that buspirone may have benefit in treating anxiety in elderly populations, although it lacks studies in this specific population 1.
- Another study published in 2014 found that duloxetine was effective in treating generalized anxiety disorder in older adult patients, but it did not address the use of buspirone in this population 2.
- The most recent and highest quality study relevant to this question is 1, which provides guidance on the pharmacological management of anxiety disorders in the elderly.