What is the recommended tapering schedule for buspirone (anxiolytic) withdrawal?

Buspirone Withdrawal Management

For buspirone withdrawal, a gradual taper over 2-4 weeks is recommended to minimize withdrawal symptoms, with a reduction of approximately 10% of the most recent dose per week for shorter-term users (less than 1 year) and 5-10% per month for long-term users. 1

Tapering Schedule Based on Duration of Use

Short-term Users (<1 year)

• Initial reduction: 10% of the most recent dose per week
• Example: For a patient on 30mg daily (15mg BID), reduce by 3mg per week
  • Week 1: 27mg daily (15mg morning, 12mg evening)
  • Week 2: 24mg daily (12mg BID)
  • Week 3: 21mg daily (12mg morning, 9mg evening)
  • Week 4: 18mg daily (9mg BID)
  • Continue until discontinuation

Long-term Users (≥1 year)

• Initial reduction: 5-10% of the most recent dose per month
• Example: For a patient on 30mg daily, reduce by 1.5-3mg per month
  • Month 1: 27-28.5mg daily
  • Month 2: 24-27mg daily
  • Month 3: 21-25.5mg daily
  • Continue until discontinuation

Managing Withdrawal Symptoms

While the evidence specifically for buspirone withdrawal is limited, general principles for managing medication withdrawal can be applied:

• Non-pharmacological approaches 1:

  • Cognitive behavioral therapy
  • Regular exercise
  • Sleep hygiene practices
  • Stress management techniques

• Pharmacological management for specific symptoms if needed 1:

  • Clonidine for sympathetic hyperactivity
  • Trazodone or hydroxyzine for insomnia and anxiety
  • NSAIDs/Acetaminophen for pain (not exceeding 3000mg daily)

Monitoring and Adjustments

• Regular follow-up at least monthly during the tapering process 1
• If withdrawal symptoms become severe, pause the taper temporarily and resume at a slower rate 1
• Consider slower tapers (5% instead of 10%) for patients with significant anxiety about the taper or during high-stress periods 1

Special Considerations

Although most evidence on tapering focuses on opioids, SSRIs, and benzodiazepines, the principles can be applied to buspirone with appropriate modifications:

• For patients with anxiety disorders, ensure appropriate non-buspirone approaches are in place before tapering 1
• Patients with comorbid depression may require closer monitoring as withdrawal symptoms can mimic depression recurrence 2
• Consider hyperbolic tapering (progressively smaller dose reductions) for patients experiencing significant withdrawal symptoms 2

Important Caveats

• Unlike benzodiazepines, there is limited evidence that buspirone causes significant physical dependence, but psychological dependence and rebound anxiety may still occur
• The tapering schedule should be adjusted based on the patient's response to dose reductions
• Document the rationale for the chosen tapering schedule and the patient's response to each dose reduction
• Withdrawal symptoms may be difficult to distinguish from recurrence of the underlying anxiety disorder

Remember that while buspirone has been studied as an aid for benzodiazepine withdrawal 3, 4, 5, with mixed results, there is limited specific evidence regarding buspirone withdrawal itself. Therefore, applying general medication tapering principles is the most prudent approach.