What is the recommended treatment and dosage of buspirone (anxiolytic medication) for generalized anxiety disorder (GAD)?

Buspirone Treatment for Generalized Anxiety Disorder (GAD)

For generalized anxiety disorder (GAD), buspirone should be initiated at 5 mg twice daily and titrated up to a maximum of 20 mg three times daily, with most patients responding to 15-30 mg total daily dose. 1, 2

Dosing Recommendations

• Initial dosage: Start with 5 mg twice daily 2, 1
• Titration: Increase gradually in 5 mg increments at 1-2 week intervals as tolerated 1, 3
• Maintenance dosage: 15-30 mg per day in divided doses 1, 4
• Maximum dosage: 60 mg per day (20 mg three times daily) 2, 1
• Dosing frequency: Can be administered as either twice daily (BID) or three times daily (TID) regimens 3, 4

Efficacy and Onset of Action

• Buspirone is FDA-approved specifically for generalized anxiety disorder (GAD) 1
• Efficacy is comparable to benzodiazepines in treating GAD symptoms 5, 6
• Onset of action is delayed compared to benzodiazepines, typically taking 2-4 weeks to become effective 2, 6
• Most suitable for patients with mild to moderate anxiety symptoms 2
• Effectiveness has been demonstrated in controlled clinical trials of outpatients with GAD 1

Advantages Over Benzodiazepines

• No significant risk of physical dependence or withdrawal symptoms 6
• Minimal sedation and cognitive impairment 6
• Does not potentiate effects of alcohol 6
• No abuse potential 6
• Particularly beneficial in elderly patients due to fewer cognitive and psychomotor effects 7

Administration Considerations

• BID dosing (15 mg twice daily) offers similar efficacy to TID dosing (10 mg three times daily) and may improve medication adherence 3, 4
• Both BID and TID regimens demonstrate significant reductions in anxiety symptoms as measured by Hamilton Anxiety Rating Scale 4
• Food increases bioavailability; consistent administration with or without food is recommended 1

Common Side Effects

• Most common adverse effects include dizziness, headache, and nausea 3
• Other potential side effects include nervousness and lightheadedness 6
• Palpitations may occur more frequently with BID dosing (5%) compared to TID dosing (1%) 3

Clinical Pearls and Caveats

• Buspirone is not effective for as-needed or acute anxiety relief due to its delayed onset of action 2
• Long-term effectiveness beyond 3-4 weeks has not been systematically established in controlled trials, though one study showed safe use for up to 1 year 1
• Physicians should periodically reassess the usefulness of the medication for individual patients during extended treatment periods 1
• Buspirone may be effective in patients with coexisting depressive symptoms 1
• Unlike benzodiazepines, buspirone lacks anticonvulsant and muscle-relaxant properties 6

Treatment Duration

• The FDA label notes that efficacy beyond 3-4 weeks has not been systematically demonstrated in controlled trials 1
• For patients requiring long-term treatment, periodic reassessment of the medication's usefulness is recommended 1