Is buspirone safe to use in patients with a seizure disorder?

Buspirone Safety in Patients with Seizure Disorders

Buspirone can be safely used in patients with seizure disorders as it does not lower the seizure threshold and has not been associated with increased seizure activity in clinical practice.

Mechanism and Safety Profile

Buspirone is an anxiolytic agent with a unique mechanism of action that differs significantly from benzodiazepines:

• Acts primarily as a partial agonist at serotonin 5-HT1A receptors 1
• Has low affinity as an antagonist for dopamine D2 autoreceptors 1
• Unlike benzodiazepines, buspirone lacks anticonvulsant properties but importantly does not lower the seizure threshold 2

Evidence Supporting Safety in Seizure Disorders

The safety profile of buspirone regarding seizures can be contrasted with other medications:

• Unlike amantadine, which has been reported to increase seizure incidence in patients with seizure disorders 3
• Unlike rimantadine, which has been associated with seizure-like activity in persons with a history of seizures 3
• Unlike naltrexone-bupropion ER, which should be avoided in patients with seizure disorders and used with caution in patients at risk of seizures 3

Clinical Applications

Buspirone has been successfully used in patients with comorbid conditions including seizure disorders:

• A case report documented successful use of buspirone in a patient with intellectual disability who also had a seizure disorder, with no worsening of seizure control 4
• Buspirone has been used safely at doses up to 90 mg daily in a patient with a seizure disorder without lowering seizure threshold 4

Dosing Considerations

When prescribing buspirone to patients with seizure disorders:

• Start with standard dosing (typically 15 mg/day divided into 2-3 doses)
• Titrate gradually based on clinical response
• No specific dose adjustment is required for patients with seizure disorders
• Monitor for common side effects which include headaches, dizziness, nervousness, and lightheadedness 2

Advantages Over Other Anxiolytics

Buspirone offers several advantages for patients with seizure disorders:

• Does not produce sedation or psychomotor impairment like benzodiazepines
• No reported abuse potential or withdrawal symptoms 2
• No need to adjust dosing for seizure risk (unlike many other anxiolytics)
• No significant drug interactions with common antiepileptic medications

Potential Concerns

While generally safe, there is one case report in the literature of a seizure occurring after buspirone overdose:

• A single case report documented a generalized tonic-clonic seizure approximately 36 hours after buspirone overdose 5
• This appears to be an isolated case and may represent an idiosyncratic reaction or effect of massive overdose
• No evidence suggests seizure risk at therapeutic doses

Clinical Recommendation

For patients with anxiety and comorbid seizure disorders:

1. Buspirone is a preferred anxiolytic option over benzodiazepines or other agents that may lower seizure threshold
2. Monitor patients during initial treatment period as with any medication
3. No special precautions regarding seizure activity are required beyond standard monitoring
4. Document baseline seizure frequency to allow for objective assessment of any changes

Buspirone represents a valuable option for treating anxiety in patients with seizure disorders due to its favorable safety profile and lack of effect on seizure threshold.