From the Guidelines
Buspirone (Buspar) can generally be taken with sertraline, but it is crucial to exercise caution and monitor for symptoms of serotonin syndrome, especially when starting the combination or adjusting doses, as advised in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. When considering the combination of buspirone and sertraline, it's essential to understand that both medications affect serotonin levels in the brain, although through different mechanisms. Sertraline is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels, while buspirone affects serotonin and dopamine receptors in a distinct way. The key to safely combining these medications is to start with the prescribed doses and closely monitor for any unusual side effects, reporting them promptly to your healthcare provider. Some patients may experience increased side effects such as dizziness, drowsiness, or headache when these medications are combined. It's also important to note that serotonin syndrome, a potentially serious drug interaction, is theoretically possible with this combination, although it is relatively uncommon when the medications are taken at prescribed doses 1. To minimize risks, always inform your doctor about all medications you're taking, including over-the-counter drugs and supplements, as they may affect how these medications work together. Never adjust your medication doses without consulting your healthcare provider first, as this can lead to adverse effects or reduce the efficacy of the treatment. Given the potential for drug-drug interactions, particularly with SSRIs like sertraline, which may interact with drugs metabolized by CYP2D6, and considering the guidance on cautious prescribing practices 1, it is vital to approach the combination of buspirone and sertraline with careful consideration and monitoring.
From the FDA Drug Label
The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including sertraline, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue). If concomitant use of sertraline with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John’s Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases
Key Points:
- Buspirone can be taken with sertraline, but with caution.
- There is a potential increased risk for serotonin syndrome when using these two drugs together.
- Patients should be monitored for the emergence of serotonin syndrome symptoms, such as mental status changes, autonomic instability, and neuromuscular symptoms.
- Treatment with sertraline and buspirone should be discontinued immediately if serotonin syndrome occurs, and supportive symptomatic treatment should be initiated 2.
From the Research
Buspar and Sertraline Interaction
- Buspar (buspirone) can be taken with sertraline, but it is essential to be aware of the potential risks of serotonin syndrome, a rare but life-threatening condition caused by excessive serotonin activity 3, 4.
- Studies have shown that the combination of buspirone and selective serotonin reuptake inhibitors (SSRIs), such as sertraline, can increase the risk of serotonin syndrome 5, 6.
- A case report described a patient who developed possible serotonin syndrome after taking buspirone and fluoxetine, another SSRI 3.
- Another study found that 59% of patients who had buspirone added to their SSRI regimen showed complete or partial remission of their depressive symptoms, with no serious side effects observed 4.
- A randomized, double-blind, placebo-controlled trial found that adding buspirone to an SSRI was a safe and well-tolerated regimen, but it did not demonstrate a significant difference in efficacy between buspirone and placebo augmentation of an SSRI 7.
Precautions and Monitoring
- Patients taking buspirone and sertraline concomitantly should be closely monitored for symptoms of serotonin syndrome, such as hyperthermia, mental status changes, autonomic hyperactivity, and neuromuscular abnormalities 5, 6.
- Healthcare providers should be cautious when prescribing buspirone to patients already taking SSRIs, and patients should be educated on the potential risks and symptoms of serotonin syndrome 3, 4.