Buspirone Titration Schedule
The recommended titration schedule for buspirone (BuSpar) is to start with 5 mg twice daily and gradually increase by 5 mg every 5-7 days as needed, up to a maximum of 20 mg three times daily (60 mg total daily dose). 1
Initial Dosing and Titration
- Start with 5 mg twice daily (10 mg/day total) 1
- Increase dose in increments of 5 mg every 5-7 days based on clinical response and tolerability 1
- Target maintenance dose typically ranges from 15-30 mg/day (divided into 2-3 doses) 2
- Maximum recommended dose is 60 mg/day (20 mg three times daily) 1
Dosing Schedule Options
- Twice daily (BID) regimen: 15 mg twice daily (30 mg/day) has shown similar efficacy and safety to three-times-daily dosing 3, 4
- Three times daily (TID) regimen: 10 mg three times daily (30 mg/day) is an alternative dosing schedule 3
- Both BID and TID regimens demonstrate comparable efficacy and safety profiles, with BID dosing potentially offering better convenience and compliance 4
Important Clinical Considerations
- Full therapeutic effect may take 2-4 weeks to become apparent 1
- Buspirone is most effective for mild to moderate anxiety 1
- Unlike benzodiazepines, buspirone does not cause significant sedation, has minimal psychomotor impairment, and has not been associated with abuse, dependence, or withdrawal symptoms 5
- Buspirone has a short half-life of approximately 2.5 hours, but its active metabolite (1-PP) has a longer half-life of about 6 hours 5, 6
Monitoring and Dose Adjustments
- Evaluate clinical response every 1-2 weeks during initial titration 1
- If inadequate response after 4-6 weeks at maximum tolerated dose, consider alternative treatment 2
- For long-term therapy, periodically reassess the need for continued treatment 2
Special Populations
- In elderly or frail patients: Consider starting at a lower dose (2.5 mg twice daily) and titrate more slowly 1
- In patients with hepatic impairment: Use lower doses as drug exposure can be 15-fold higher 6
- In patients with renal impairment: Consider dose reduction as drug exposure may be doubled 6
Common Side Effects to Monitor
- Most common side effects include dizziness, headache, and nausea 4
- Less common side effects include nervousness, lightheadedness, and palpitations (more common with BID dosing) 5, 4
- Side effects are generally mild and transient, often resolving with continued treatment 2
Drug Interactions
- Avoid concurrent use with MAO inhibitors
- Use caution with CYP3A4 inhibitors (e.g., erythromycin, itraconazole, verapamil, diltiazem) as they can substantially increase buspirone concentrations 6
- CYP3A4 inducers (e.g., rifampin) can decrease buspirone concentrations by up to 10-fold 6
- Taking with food can increase bioavailability approximately 2-fold 6