Maximum Recommended Dose of Buspirone (BuSpar) Per Day
The maximum recommended dose of buspirone (BuSpar) is 60 mg per day, typically administered as 20 mg three times daily.
Dosing Guidelines
Buspirone dosing should follow these parameters:
- Initial dosage: 5 mg twice daily or three times daily 1
- Titration: Gradually increase dose by 5 mg per day every 2-3 days as needed
- Therapeutic range: 15-30 mg per day (most common effective dosage) 2
- Maximum daily dose: 60 mg per day (20 mg three times daily) 1, 3
Administration Considerations
- Buspirone can be administered in divided doses, either twice daily (BID) or three times daily (TID)
- Research shows no significant difference in efficacy or safety between BID and TID dosing regimens when using the same total daily dose 4, 5
- Taking buspirone with food can increase the maximum plasma concentration (Cmax) and bioavailability approximately 2-fold 6
- The medication should be taken consistently either with or without food to maintain stable blood levels
Special Populations
Hepatic Impairment
- Patients with hepatic impairment may experience 15-fold higher drug concentrations 6
- Dose reduction is necessary in these patients
- The elimination half-life is doubled in patients with liver disease
Renal Impairment
- Patients with renal impairment may experience 2-fold higher drug concentrations 6
- Dose reduction may be necessary
Elderly Patients
- No specific dose adjustments are required based on age alone 6
- However, lower starting doses may be prudent due to potential comorbidities
Drug Interactions
Important interactions to consider:
- CYP3A4 inhibitors (verapamil, diltiazem, erythromycin, itraconazole): Substantially increase buspirone plasma concentrations; dose reduction may be necessary 6
- CYP3A4 inducers (rifampin): Can decrease buspirone plasma concentrations by approximately 10-fold; dose adjustments may be required 6
Safety Considerations
- Long-term studies have shown that buspirone can be safely used for up to one year without emergence of new or unexpected side effects 2
- Most common adverse effects include dizziness, headache, and nausea 5
- No evidence of withdrawal syndrome has been observed after abrupt discontinuation following 6+ months of therapy 2
- In overdose cases, symptoms may include nausea, vomiting, dizziness, drowsiness, miosis, and gastric distress 3
Clinical Pearls
- Buspirone has a delayed onset of action (2-4 weeks) compared to benzodiazepines 1
- It is particularly useful for patients with mild to moderate agitation 1
- Periodic reevaluation of the need for continued therapy is recommended for patients on long-term treatment 2
- Unlike benzodiazepines, buspirone does not cause significant cognitive impairment, tolerance, or physical dependence