Can Buspirone (an anxiolytic medication) cause orthostatic hypotension and lightheadedness, particularly in a patient who recently switched from Sertraline (an selective serotonin reuptake inhibitor) to Buspirone for anxiety treatment?

From the FDA Drug Label

ADVERSE REACTIONS (See also PRECAUTIONS) Commonly Observed The more commonly observed untoward events associated with the use of buspirone hydrochloride tablets not seen at an equivalent incidence among placebo-treated patients include dizziness, nausea, headache, nervousness, lightheadedness, and excitement ... Cardiovascular Tachycardia/Palpitations1 CNS Dizziness12 Drowsiness10 Nervousness5 Insomnia3 Lightheadedness3

Buspirone can cause orthostatic hypotension and lightheadedness.

• The drug label reports that lightheadedness is a commonly observed adverse event associated with the use of buspirone hydrochloride tablets.
• The incidence of lightheadedness in controlled clinical trials was 3% in the buspirone group.
• Dizziness is also a commonly reported adverse event, with an incidence of 12% in the buspirone group. There is no specific information in the drug label about the risk of orthostatic hypotension and lightheadedness in patients who recently switched from Sertraline to Buspirone. 1 1

From the Research

Yes, buspirone can cause lightheadedness and hypotension, which may explain the symptoms the patient is experiencing after switching from sertraline. The most recent and highest quality study, 2, although focused on a specific population, supports the notion that buspirone can be effective for anxiety but does not directly address the question of orthostatic hypotension and lightheadedness. However, an earlier study, 3, provides more relevant information, indicating that buspirone can cause lightheadedness in a significant portion of patients, especially during the initial weeks of treatment.

Key Points to Consider:

• Buspirone's side effects, including dizziness and lightheadedness, are more common during the initial treatment phase, as noted in 3.
• The mechanism of action of buspirone, involving serotonin and dopamine receptors, can influence blood pressure regulation, potentially leading to orthostatic hypotension, as discussed in 4.
• While the patient's switch from sertraline to buspirone might be intended to mitigate certain side effects, careful monitoring is necessary due to the potential for similar side effects, such as dizziness, with buspirone.
• The typical starting dose of buspirone is 7.5-15 mg daily, and if symptoms persist or worsen, consulting a healthcare provider for potential adjustments, such as taking the medication with food or altering the dosing schedule, is advisable.

Recommendations:

• Patients starting buspirone should be aware of the potential for lightheadedness and orthostatic hypotension, especially during the initial weeks of treatment.
• Monitoring and potentially adjusting the dosage or administration method (e.g., taking with food) can help manage these side effects.
• Given the potential for buspirone to cause dizziness and lightheadedness, as reported in 3, patients should be cautious when changing positions and ensure adequate hydration.