What is the recommended tapering schedule for buspirone (Buspar) 20mg twice a day (BID)?

Buspirone Tapering Protocol

A gradual taper of buspirone 20mg BID should follow a reduction of 10% of the original dose per week, which is approximately 5mg per week, divided across both daily doses.

Recommended Tapering Schedule for Buspirone 20mg BID

• Begin with a reduction of 10% of the total daily dose (40mg) per week, which equals approximately 5mg per week 1
• Reduce the dose by 2.5mg BID in the first week (to 17.5mg BID) 1
• Continue with weekly reductions of 2.5mg BID until reaching 10mg BID 1
• At lower doses (10mg BID and below), slow the taper further to 1-2mg reductions per week 1
• Once at the smallest available dose (5mg), consider extending the interval between doses before discontinuation 1

Rationale for This Approach

• Buspirone has a short half-life of approximately 2-3 hours, which influences the tapering strategy 2
• Unlike benzodiazepines, buspirone has not been associated with significant physical dependence, but a gradual taper is still recommended to minimize potential withdrawal symptoms 3
• The 10% reduction per week approach is consistent with general tapering guidelines for centrally acting medications 1

Monitoring During Tapering

• Assess for withdrawal symptoms after each dose reduction before proceeding to the next step 1
• Common withdrawal symptoms to monitor include anxiety, insomnia, irritability, and potential return of original anxiety symptoms 1
• If withdrawal symptoms occur, return to the previous well-tolerated dose and slow the taper further 1

Special Considerations

• For patients who have been taking buspirone for longer durations (≥1 year), consider a slower taper of 10% per month rather than per week 1, 3
• Patients with hepatic impairment may require even slower tapering as buspirone has a longer half-life in these individuals 2
• Consider adjunctive treatments to manage any emerging anxiety symptoms during the taper 1

Potential Pitfalls to Avoid

• Avoid abrupt discontinuation, which increases risk of withdrawal symptoms and anxiety rebound 1
• Do not use a fixed tapering schedule for all patients; be prepared to adjust based on individual response 1
• Remember that buspirone is metabolized extensively in the liver, so patients with hepatic impairment may need an even more gradual taper 2

Follow-up Recommendations

• Schedule follow-up appointments at each dose reduction stage to assess tolerance 1
• If anxiety symptoms re-emerge during tapering, consider pausing the taper at the current dose before continuing 1
• Document the patient's response to guide future treatment decisions if needed 1