What is the recommended starting dose of Buspar (buspirone) for adults?

Recommended Starting Dose of Buspirone (BuSpar) for Adults

The recommended starting dose of buspirone (BuSpar) for adults is 5 mg twice daily. 1

Dosing Guidelines

• Initial dosage should be 5 mg twice daily for anxiety management 1
• After starting treatment, the dose can be gradually increased if needed:
  • Increase by 5 mg per day at 2-3 day intervals 2
  • Typical maintenance dose ranges from 15-30 mg per day in divided doses 3
  • Maximum recommended dose is 60 mg per day (20 mg three times daily) 1

Special Population Considerations

• For elderly patients: Start with the same 5 mg twice daily dose 4
  • Elderly patients have shown good response at similar doses to younger adults (mean effective dose of 18 mg/day in elderly) 4
• For patients with hepatic impairment: Use lower starting doses 2
  • Patients with hepatic impairment show 15-fold higher drug concentrations compared to healthy individuals 2
• For patients with renal impairment: Consider lower starting doses 2
  • Renal impairment can double drug concentration compared to healthy individuals 2

Clinical Efficacy Timeline

• Buspirone may take 2-4 weeks to become fully effective 1
• Unlike benzodiazepines, buspirone does not provide immediate relief of anxiety symptoms 5
• Patient education about this delayed onset is important to ensure adherence to treatment 5

Advantages of Buspirone

• Low risk of sedation compared to benzodiazepines 5
• No significant impairment of psychomotor or cognitive function 5
• Limited potential for abuse and dependence 5
• No withdrawal syndrome observed after abrupt discontinuation, even after long-term use 3
• Particularly useful for patients in whom daytime alertness is important 5

Important Clinical Considerations

• Buspirone is most effective for mild to moderate anxiety 1
• Food increases drug absorption and bioavailability by approximately 2-fold 2
• Drug interactions should be monitored, particularly with:
  • Verapamil, diltiazem, erythromycin, and itraconazole (increase buspirone levels) 2
  • Rifampin (decreases buspirone levels by approximately 10-fold) 2
• Periodic reevaluation of the need for continued therapy is recommended for patients on long-term treatment 3