Buspirone Dosage for Generalized Anxiety Disorder (GAD)
For treating generalized anxiety disorder (GAD), buspirone should be started at 5 mg twice daily and gradually titrated to a target dose of 20-30 mg per day in divided doses, with a maximum of 60 mg daily. 1
Initial Dosing and Titration
- Starting dose: 5 mg twice daily
- Titration: Gradually increase dose over several weeks
- Target dose: 20-30 mg/day (divided into 2-3 doses)
- Maximum dose: 60 mg/day
The dosing can be administered in either:
- Twice daily regimen: 15 mg twice daily (30 mg total)
- Three times daily regimen: 10 mg three times daily (30 mg total)
Both regimens show similar efficacy and safety profiles 1, 2, 3, so the choice between BID or TID dosing can be based on patient preference and convenience to improve adherence.
Special Populations
- Elderly patients: Start at lower doses and titrate more slowly 1
- Hepatic/renal impairment: Use lower doses with cautious titration 1, 4
- Severe hepatic or renal impairment: Buspirone administration is not recommended due to increased plasma levels and lengthened half-life 4
Timing and Expectations
- Onset of action: Full therapeutic effect takes 2-4 weeks to manifest 1
- Assessment: Evaluate therapeutic response after 2-4 weeks of treatment 1
- Duration: If effective, treatment may continue for maintenance therapy
Monitoring and Discontinuation
Discontinuation criteria: Consider discontinuing if:
- Inadequate response after 4-6 weeks at therapeutic doses
- Intolerable side effects occur
Common side effects to monitor:
Important Clinical Considerations
- Unlike benzodiazepines, buspirone lacks sedative, muscle relaxant, and anticonvulsant properties 1, 5
- No evidence of dependence, tolerance, or withdrawal syndrome 1
- Patients previously treated with benzodiazepines may perceive buspirone as less effective due to the lack of immediate sedative effects 1
- Buspirone has demonstrated efficacy in GAD patients with coexisting mild depressive symptoms 6
- In elderly patients with GAD, buspirone shows significant anxiolytic effects, with some studies suggesting faster onset compared to SSRIs like sertraline 1, 7
Practical Tips
- Consider starting with a subtherapeutic "test" dose as initial adverse effects can include increased anxiety or agitation 1
- Taking with food may decrease nausea
- Inform patients about the delayed onset of action to manage expectations and improve adherence
- Buspirone is not effective for panic disorder and should not be used for this indication 1