Can Buspirone (Buspar) worsen tardive dyskinesia?

Buspirone Does Not Worsen Tardive Dyskinesia

Buspirone (Buspar) does not worsen tardive dyskinesia (TD) and may actually be considered as an adjunctive treatment option, though evidence for its efficacy in TD is limited.

Key Evidence from FDA Drug Label

The FDA label for buspirone explicitly addresses this concern 1. While buspirone binds to central dopamine receptors—raising theoretical concerns about movement disorders—clinical experience in controlled trials has failed to identify any significant neuroleptic-like activity 1. The label notes that postmarketing reports have included rare occurrences of dyskinesias (both acute and tardive), but these are voluntary reports where a causal relationship to buspirone treatment has not been determined 1.

Clinical Research Findings

The evidence presents a nuanced picture:

Evidence Against Worsening TD:

• In a controlled trial of 20 chronic schizophrenic patients, buspirone (mean dose 23.8 mg/day) added to stable neuroleptics showed no significant changes in overall measures of tardive dyskinesia at 6 weeks 2. This is the most relevant controlled study addressing your question directly.

• A 2024 randomized controlled crossover study demonstrated that buspirone combined with zolmitriptan actually reduced dyskinesia severity in Parkinson's disease patients without worsening motor function 3.

Case Reports of Movement Disorders:

• A 1993 report described two patients with persistent movement disorders after buspirone treatment, including one with exacerbation of preexisting TD 4. However, this patient had preexisting spasmodic torticollis and tardive dyskinesia before buspirone was started.

• A 2020 literature review identified only 65 cases of buspirone-associated movement disorders across 25 reports, with only 14 cases of dyskinesia 5. Notably, in cases where follow-up was reported, 87.5% had complete recovery within one month of buspirone withdrawal.

Clinical Practice Implications

If a patient has established TD:

• Buspirone can be used cautiously for anxiety management, as controlled evidence does not demonstrate worsening of TD 2
• Monitor movement symptoms closely, particularly in the first month of treatment (when 76% of buspirone-associated movement disorders occur if they develop) 5
• The theoretical risk based on dopamine receptor binding has not translated into clinically significant TD worsening in controlled studies

Important Caveats:

• Patients with preexisting movement disorders may be at higher risk for exacerbation 4
• The syndrome of restlessness (possibly akathisia) appearing shortly after buspirone initiation occurs in a small fraction of patients and should not be confused with TD worsening 1
• European guidelines mention buspirone as one of only five pharmaceutical treatments receiving any recommendation for TD (though without high-quality evidence ranking) 6

Practical Algorithm:

1. Document baseline TD severity using AIMS (Abnormal Involuntary Movement Scale) before starting buspirone
2. Start buspirone at low doses (5-10 mg twice daily)
3. Reassess movement symptoms at 2 weeks and 1 month
4. If movement symptoms worsen, discontinue buspirone (87.5% of cases resolve within one month) 5
5. If TD remains stable or improves, continue buspirone as clinically indicated

The preponderance of evidence, particularly from controlled trials, supports that buspirone does not worsen TD in most patients and may be safely used when anxiety management is needed in patients with existing TD.