Buspirone (Buspar) Titration Schedule
The recommended titration schedule for buspirone begins with 5 mg twice daily, with gradual increases of 5 mg every 5-7 days as needed, up to a maximum of 60 mg per day (20 mg three times daily). 1
Initial Dosing
- Start with 5 mg twice daily (10 mg total daily dose) 1
- For elderly or frail patients, consider starting at a lower dose of 2.5 mg twice daily 1
Titration Process
- Increase dose in increments of 5 mg every 5-7 days based on clinical response and tolerability 1
- Evaluate clinical response every 1-2 weeks during the initial titration period 1
- Most patients are successfully managed on daily doses ranging from 15 to 30 mg/day 2
Maximum Dosing
- Maximum recommended dose is 60 mg/day (typically divided as 20 mg three times daily) 1
- No additional benefit has been consistently demonstrated at doses higher than this maximum 1
Administration Considerations
- Buspirone can be administered in either twice-daily (BID) or three-times-daily (TID) regimens with similar efficacy and safety profiles 3
- Taking buspirone with food can increase the bioavailability approximately 2-fold 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
- No evidence of withdrawal syndrome has been observed when buspirone is discontinued after long-term use 2
- The drug has a short half-life of approximately 2.5 hours 4
Special Populations
- In patients with hepatic impairment, plasma concentrations can be 15-fold higher, and the half-life is doubled; consider lower doses 4
- In patients with renal impairment, plasma concentrations may be doubled; dose adjustment may be necessary 4
- Avoid concurrent use with MAO inhibitors 1
- Use caution when co-administering with medications that inhibit CYP3A4 (e.g., verapamil, diltiazem, erythromycin, itraconazole) as they can substantially increase buspirone plasma concentrations 4