Buspirone Treatment for Generalized Anxiety Disorder (GAD)
For generalized anxiety disorder (GAD), buspirone should be initiated at 5 mg twice daily and gradually titrated to an effective dose of 20-30 mg/day in divided doses, with a maximum of 60 mg/day. 1
Initial Dosing and Titration
- Start with 5 mg twice daily 2, 1
- Gradually increase the dose over 2-4 weeks 2
- Target effective dose range: 20-30 mg/day in divided doses 1
- Maximum recommended dose: 60 mg/day 1, 3
- May take 2-4 weeks to become effective, requiring patient education about delayed onset 2
Clinical Evidence and Efficacy
- Buspirone is FDA-approved for the management of anxiety disorder or short-term relief of anxiety symptoms 3
- Efficacy has been demonstrated in controlled clinical trials of outpatients with diagnoses corresponding to GAD 3
- Buspirone shows comparable anxiolytic efficacy to benzodiazepines in clinical trials 4
- Effective for both BID (15 mg twice daily) and TID (10 mg three times daily) dosing regimens, with no significant difference in efficacy between the two 5, 6
Advantages and Patient Selection
- Particularly useful for patients with mild to moderate anxiety/agitation 2, 1
- Does not cause tolerance, dependency, or cognitive impairment, making it safer for long-term use 1
- Lacks anticonvulsant and muscle-relaxant properties, and causes minimal sedation compared to benzodiazepines 7
- Effective in patients with GAD who have coexisting mild depressive symptoms 8
Common Side Effects
- Most frequently reported adverse events are dizziness, headache, and nausea 6
- Other potential side effects include nervousness, lightheadedness, and somnolence 7, 8
- The BID dosing regimen may have slightly higher incidence of palpitations (5%) compared to TID dosing (1%) 6
Duration of Treatment
- The effectiveness of buspirone in long-term use (beyond 3-4 weeks) has not been systematically demonstrated in controlled trials 3
- However, in a study of long-term use, 264 patients were treated with buspirone for 1 year without ill effects 3
- For extended treatment periods, physicians should periodically reassess the usefulness of the drug for the individual patient 3
Special Considerations
- Buspirone is most helpful for anxious patients who do not require immediate relief, as it has a slower onset of action compared to benzodiazepines 4
- BID dosing may offer convenience and possibly higher compliance without compromising safety and tolerability 6
- Not recommended for routine treatment of panic disorder based on inconclusive studies 4