Buspirone and Seizure Threshold
Buspirone does not significantly decrease seizure threshold and is generally considered a safer anxiolytic option for patients with seizure disorders compared to many other psychotropic medications.
Seizure Risk Profile of Buspirone
Buspirone has a favorable seizure risk profile compared to many other psychotropic medications:
- Unlike medications such as bupropion which have well-documented seizure risks 1, 2, 3, buspirone has minimal impact on seizure threshold
- According to European Heart Journal guidelines, buspirone can be safely used in combination with meperidine for shivering management during targeted temperature management, with the main caution being that high-dose buspirone (30 mg) should be used with caution in those at risk of seizure 4
- While there is a case report of seizure associated with buspirone overdose 5, this is extremely rare and occurred approximately 36 hours after ingestion in an overdose situation, not at therapeutic doses
Clinical Applications and Safety Considerations
Appropriate Use Cases
- Buspirone is recommended for patients with mild to moderate agitation, with a typical starting dose of 5 mg twice daily and maximum dosage of 20 mg three times daily 4
- It may take 2-4 weeks to become effective, making it suitable for chronic anxiety rather than acute agitation 4
Specific Patient Populations
- For patients with seizure disorders, buspirone represents a safer anxiolytic choice compared to:
- Benzodiazepines (which can lead to withdrawal seizures upon discontinuation)
- Bupropion (which has a well-documented seizure risk of approximately 0.4% at recommended doses) 3
- Tricyclic antidepressants (which have anticholinergic and cardiotoxic effects)
Important Monitoring Considerations
- When using buspirone in patients with a history of seizures:
- Start at the lowest effective dose (typically 5 mg twice daily)
- Titrate slowly based on clinical response
- Monitor for any changes in seizure frequency or pattern
- Avoid abrupt discontinuation
Comparative Seizure Risk Among Psychotropic Medications
Medications with higher seizure risk that should be used with caution in patients with seizure disorders include:
- Bupropion - contraindicated in patients with seizure disorders 6, 1
- Clozapine - estimated cumulative seizure risk of 10% in patients treated for 3.8 years 3
- Tricyclic antidepressants - can lower seizure threshold, particularly at higher doses
Conclusion
While no medication is completely without risk, buspirone has minimal impact on seizure threshold at therapeutic doses and represents one of the safer anxiolytic options for patients with or at risk for seizures. The rare reports of seizures with buspirone have generally been in overdose situations rather than at therapeutic doses.