What is the next dose increase for buspirone (buspirone) 5 mg three times a day (tid)?

Buspirone Dose Titration Protocol

The next dose increase for buspirone from 5 mg tid should be to 7.5 mg tid, with further increases of 5 mg per day at 2-3 day intervals as needed, up to a maximum of 60 mg per day. 1

Dosing Guidelines

According to the FDA-approved labeling, buspirone dosing follows a specific titration protocol:

• Initial recommended dose: 15 mg daily (7.5 mg twice daily)
• Titration: Increase by 5 mg per day at intervals of 2-3 days as needed
• Maximum daily dose: 60 mg per day
• Common effective doses: 20-30 mg per day in divided doses 1

Titration Algorithm

For a patient currently on 5 mg tid (15 mg/day):

1. Increase to 7.5 mg tid (22.5 mg/day)
2. If inadequate response after 2-3 days, increase to 10 mg tid (30 mg/day)
3. Continue increasing in 5 mg/day increments as needed
4. Maintain consistent timing with respect to food intake 1

Clinical Considerations

Efficacy

• Buspirone is effective for generalized anxiety disorder, with efficacy comparable to benzodiazepines 2
• Full therapeutic effect may take 2-4 weeks to become apparent 3
• Most patients are successfully managed on daily doses ranging from 15-30 mg/day 4

Pharmacokinetics

• Rapid absorption with peak plasma concentration under 1 hour
• Short half-life of approximately 2.5 hours
• Extensively metabolized with linear pharmacokinetics 5
• Food increases bioavailability by approximately 2-fold 5

Safety Profile

• Most common side effects: dizziness, headache, and nausea 6
• No evidence of withdrawal syndrome when discontinued after long-term use 4
• Unlike benzodiazepines, buspirone lacks sedative properties and has minimal psychomotor impairment 2

Important Precautions

• Bioavailability increases when taken with food, so maintain consistent timing relative to meals 1
• Dose adjustment needed with hepatic impairment (plasma concentrations can be 15-fold higher) 5
• Dose adjustment needed with renal impairment (2-fold increase in plasma concentration) 5
• Significant drug interactions with CYP3A4 inhibitors (verapamil, diltiazem, erythromycin, itraconazole) require dose adjustment 5

Monitoring

• Evaluate therapeutic response every 2-3 days during dose titration
• Periodically reassess the need for continued therapy during long-term treatment 4
• Monitor for common side effects: headache, dizziness, nervousness, and lightheadedness 2

Buspirone's unique mechanism of action as a 5-HT1A partial agonist provides anxiolytic effects without the sedation, dependence, and withdrawal concerns associated with benzodiazepines, making it particularly valuable for patients requiring long-term anxiety management.