From the Guidelines
Discontinuing buspirone (Buspar) can lead to increased anxiety, and it is crucial to taper off the medication gradually under medical supervision to minimize potential withdrawal symptoms and the return of original anxiety symptoms. When considering discontinuation, it's essential to develop a personalized tapering plan with a healthcare provider, as the optimal tapering schedule may vary based on individual needs 1. A gradual reduction in dose, such as decreasing by 5mg every 1-2 weeks, can help mitigate withdrawal symptoms, including increased anxiety, irritability, and dizziness.
Key Considerations for Discontinuation
- The return of original anxiety symptoms is a significant concern when discontinuing buspirone, as it works by affecting serotonin and dopamine receptors in the brain, and removing the medication requires these neurotransmitter systems to readjust 1.
- Alternative treatments or coping strategies for managing anxiety during and after discontinuation should be discussed with a healthcare provider.
- Nonpharmacological psychosocial interventions, such as cognitive-behavioral therapy, problem-solving, and supportive psychotherapy, may be effective in reducing anxiety symptoms and can be considered as part of the discontinuation plan 1.
Tapering Schedule
- A gradual withdrawal strategy is recommended to minimize potential discontinuation effects, with a tapering schedule extending over a period of greater than 1 month 1.
- The EMPOWER trial demonstrated success with a gradual reduction over many weeks, resulting in 27% of patients stopping benzodiazepines compared to 5% in the control group 1.
- However, the optimal tapering schedule for buspirone may vary, and individualized plans should be developed in consultation with a healthcare provider.
Importance of Medical Supervision
- Discontinuing buspirone without medical supervision can lead to increased anxiety and other withdrawal symptoms, emphasizing the need for a healthcare provider's guidance throughout the tapering process 1.
- Regular monitoring and adjustments to the tapering schedule as needed can help minimize potential complications and ensure a safe discontinuation process.
From the FDA Drug Label
Potential for Withdrawal Reactions in Sedative/Hypnotic/Anxiolytic Drug-Dependent Patients ... Rebound or withdrawal symptoms may occur over varying time periods, depending in part on the type of drug, and its effective half-life of elimination The syndrome of withdrawal from sedative/hypnotic/anxiolytic drugs can appear as any combination of irritability, anxiety, agitation, insomnia, tremor, abdominal cramps, muscle cramps, vomiting, sweating, flu-like symptoms without fever, and occasionally, even as seizures
The discontinuation of buspirone (Buspar) may increase anxiety as part of a withdrawal syndrome in patients who have been using a CNS-depressant drug chronically 2.
From the Research
Discontinuation of Buspirone and Anxiety
- The discontinuation of buspirone does not appear to increase anxiety in patients, according to several studies 3, 4, 5, 6.
- A study published in 1991 found that buspirone is unlikely to be followed by rebound or long-term use through dependence, and abuse is unlikely to be a problem 3.
- Another study from 1995 found that buspirone-treated patients showed no rebound anxiety or benzodiazepine-withdrawal syndrome compared with placebo, and buspirone maintained its anxiolytic effect for at least 2 weeks after the discontinuation of treatment 4.
- A 1987 study reviewed the results of animal and clinical studies and found that buspirone appears to lack abuse liability and does not lead to drug dependence or withdrawal symptoms 5.
- A long-term study published in 1990 found that when buspirone therapy was abruptly discontinued after more than six months of therapy, assessments of patients yielded no evidence of a withdrawal syndrome or unusual events 6.
- Additionally, a 1995 study found that buspirone-treated patients tended to have lower anxiety levels than placebo-treated patients during benzodiazepine withdrawal 7.