Can Buspirone Cause Tardive Dyskinesia?
Yes, buspirone can cause tardive dyskinesia, as explicitly stated in its FDA drug label, although it occurs rarely compared to typical antipsychotics.
Evidence from Drug Label and Guidelines
The FDA drug label for buspirone specifically lists tardive dyskinesia among its reported adverse effects in the postmarketing experience section 1. According to the label, voluntary reports since introduction have included rare occurrences of dyskinesias (both acute and tardive), along with other movement disorders such as dystonic reactions, extrapyramidal symptoms, and akathisia.
While buspirone is not an antipsychotic medication (it's an anxiolytic), it does have some dopaminergic activity that may explain this potential side effect:
The FDA label notes that "because buspirone can bind to central dopamine receptors, a question has been raised about its potential to cause acute and chronic changes in dopamine-mediated neurological function (e.g., dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia)" 1.
The American Academy of Child and Adolescent Psychiatry practice parameters acknowledge that tardive dyskinesia is primarily associated with antipsychotic medications but can occur with other agents that affect dopaminergic function 2.
Mechanism and Risk Factors
The mechanism behind buspirone-induced tardive dyskinesia likely relates to its dopaminergic properties:
Buspirone is a partial agonist for serotonin 5-HT1A receptors but also has antagonist activity at dopamine D2 autoreceptors 3.
This dopaminergic activity, though less potent than with antipsychotics, provides a plausible mechanism for movement disorders including tardive dyskinesia.
The risk appears to be significantly lower than with typical antipsychotics, which can cause tardive dyskinesia in up to 50% of elderly patients after 2 years of continuous use 2, 4.
Case Reports and Research Evidence
Several case reports document movement disorders associated with buspirone:
A 1993 report described two patients who developed persistent movement disorders after buspirone treatment. One patient developed cervical-cranial dystonia and tremors, while another experienced exacerbation of preexisting spasmodic torticollis and tardive dyskinesia 5.
A 2020 literature review identified 65 cases of buspirone-associated movement disorders, including 14 cases of dyskinesia and other movement disorders like akathisia, myoclonus, parkinsonism, and dystonia 6.
Clinical Implications
If tardive dyskinesia develops while on buspirone:
Consider discontinuation of the medication, as most cases resolve within one month of withdrawal 6.
Regular monitoring using standardized tools like the Abnormal Involuntary Movement Scale (AIMS) is recommended for patients on medications with potential to cause tardive dyskinesia 2, 4.
For persistent cases, VMAT2 inhibitors (valbenazine or deutetrabenazine) may be considered as they are FDA-approved treatments for tardive dyskinesia 4.
Conclusion
While buspirone is generally considered to have a better safety profile regarding movement disorders compared to antipsychotics, clinicians should be aware that it can rarely cause or exacerbate tardive dyskinesia due to its effects on dopamine receptors. The FDA drug label explicitly acknowledges this risk, and case reports in the literature confirm its occurrence.