What is the recommended taper for Buspar (Buspirone) 5mg BID?

Tapering Buspirone (Buspar) 5mg BID

For tapering buspirone 5mg BID, reduce the dose by 2.5mg (half a tablet) every 5-7 days until discontinuation is complete. 1

Understanding Buspirone Characteristics

Buspirone is a non-benzodiazepine anxiolytic medication with several important pharmacological characteristics that influence its tapering process:

• Short half-life of approximately 2-3 hours 2
• No evidence of physical dependence or withdrawal syndrome even after long-term use 3
• Works as a 5-HT1A receptor partial agonist rather than affecting GABA receptors like benzodiazepines 4
• Typically dosed at 15-30mg daily for anxiety disorders 1, 3

Recommended Tapering Schedule

For a patient on 5mg BID (10mg total daily dose):

1. Week 1: Reduce to 5mg in morning and 2.5mg in evening
2. Week 2: Reduce to 2.5mg twice daily
3. Week 3: Reduce to 2.5mg once daily
4. Week 4: Discontinue completely

This gradual approach is based on the general principle of tapering psychoactive medications by approximately 10% of the dose per week 1.

Why Gradual Tapering is Recommended

Although buspirone does not cause physical dependence like benzodiazepines, a gradual taper is still preferred because:

• It allows monitoring for re-emergence of anxiety symptoms
• It provides time for neuroreceptor adaptation
• It reduces the risk of rebound anxiety
• It aligns with best practices for discontinuing psychoactive medications 1

Monitoring During Taper

During the tapering process, monitor for:

• Return of anxiety symptoms
• Sleep disturbances
• Irritability or mood changes
• Somatic symptoms (headaches, dizziness)

Important Considerations

• Unlike benzodiazepines, buspirone does not produce withdrawal symptoms when discontinued abruptly 3
• Studies have shown that buspirone can be safely discontinued after long-term use without evidence of a withdrawal syndrome 3
• If anxiety symptoms return during tapering, consider slowing the taper rate
• The taper can be accelerated if the patient is tolerating it well

Special Circumstances

If the patient is switching to another anxiolytic medication, consider:

• Initiating the new medication before completing the buspirone taper
• Cross-tapering by gradually decreasing buspirone while increasing the new medication

Clinical Pearls

• Buspirone has a more favorable safety profile compared to benzodiazepines for long-term anxiety treatment 4
• Unlike benzodiazepines, buspirone does not cause sedation, cognitive impairment, or physical dependence 4
• Buspirone can be dosed either BID or TID with similar safety profiles 5
• If anxiety symptoms return during or after tapering, reassess the need for continued treatment or alternative therapies