What is the maximum recommended dosage for buspirone (anxiolytic medication)?

Maximum Dosage for Buspirone

The maximum daily dosage of buspirone should not exceed 60 mg per day, typically administered in divided doses. 1

Dosing Guidelines

Buspirone dosing follows a specific titration schedule to achieve optimal therapeutic effect while minimizing side effects:

• Initial dose: 15 mg daily (7.5 mg twice daily)
• Titration: Increase by 5 mg per day at intervals of 2-3 days as needed
• Typical therapeutic range: 20-30 mg per day in divided doses
• Maximum dose: 60 mg per day 1

Administration Considerations

• Consistency with food: Buspirone should be taken consistently either always with food or always without food, as food increases its bioavailability 1
• Divided dosing: The total daily dose should be divided, typically administered 2-3 times per day
• Duration of therapy: For chronic anxiety, the need for continued therapy should be reevaluated periodically 2

Special Populations and Dose Adjustments

Hepatic Impairment

Patients with hepatic impairment may require significant dose reduction as:

• Buspirone concentrations can be 15-fold higher in these patients
• Half-life is approximately doubled 3

Renal Impairment

• Patients with renal impairment may have twice the normal drug exposure
• Consider starting at lower doses and titrating more cautiously 3

Drug Interactions

Dose adjustments are necessary when buspirone is co-administered with:

• CYP3A4 inhibitors (verapamil, diltiazem, erythromycin, itraconazole): Substantially increase buspirone plasma concentrations, requiring dose reduction
• CYP3A4 inducers (rifampin): Can decrease buspirone plasma concentrations up to 10-fold 3

Important Precautions

• MAOIs: Allow at least 14 days between discontinuing an MAOI and starting buspirone (and vice versa) 1
• Reversible MAOIs (linezolid, methylene blue): Do not start buspirone in patients on these medications due to risk of serotonin syndrome 1
• Onset of action: Buspirone may take 2-4 weeks to become effective for anxiety symptoms 4

Common Pitfalls to Avoid

• Exceeding maximum dose: Going beyond 60 mg/day has not been shown to provide additional benefit and may increase side effects
• Abrupt discontinuation: While buspirone does not appear to cause withdrawal symptoms like benzodiazepines 2, gradual tapering is still preferred
• Inconsistent administration: Taking buspirone sometimes with food and sometimes without can lead to variable absorption and unpredictable effects 1
• Inadequate duration of trial: Failing to wait the full 2-4 weeks needed to see therapeutic effect may lead to premature discontinuation

Remember that buspirone is indicated for mild to moderate anxiety and is not effective for all types of anxiety disorders or for benzodiazepine withdrawal 5.