From the Guidelines
It's generally recommended to restart buspirone at a lower dose of 7.5 mg BID rather than immediately resuming the previous 10 mg BID dose, even if the patient tolerated it well in the past. This approach allows the patient's body to readjust to the medication after a prolonged absence, potentially reducing side effects like dizziness, headache, or nausea that can occur when starting at higher doses.
Key Considerations
- The dose can then be titrated up to 10 mg BID after about a week if the lower dose is well tolerated.
- This cautious approach is particularly important since several years have passed since the patient last took buspirone, and their physiological response to the medication may have changed.
- Starting at a lower dose helps confirm that the patient still tolerates the medication well before advancing to their previous therapeutic dose.
- According to the guidelines for managing behavior and mood disorders 1, buspirone is recommended to be started at an initial dosage of 5 mg twice daily, with a maximum of 20 mg three times daily, suggesting a gradual increase in dose is advisable.
- Buspirone typically takes 2-4 weeks to reach full therapeutic effect, so a brief titration period won't significantly delay clinical benefit while potentially improving tolerability.
Clinical Decision Making
- The patient's previous tolerance of 10 mg BID does not guarantee the same response after a few years, making a cautious approach prudent.
- Regular monitoring of the patient's response to the medication and adjustment of the dose as needed is crucial to minimize potential side effects and ensure the patient receives the optimal therapeutic benefit.
From the Research
Restarting Buspirone Treatment
- There are no studies that directly address the issue of restarting buspirone treatment at the same dose after a few years.
- However, the available evidence suggests that buspirone is generally well-tolerated and has a low risk of adverse effects 2, 3, 4, 5.
- A study on the long-term use of buspirone found that chronic use for up to 52 weeks was associated with no new or unexpected side effects, and most patients were successfully managed on daily doses ranging from 15 to 30 mg/day 4.
- Another study compared the safety and tolerability of two dose regimens of buspirone (15 mg BID and 10 mg TID) and found that the incidence of adverse events was similar between the two treatment groups 5.
- Although the evidence does not specifically address the issue of restarting treatment, it suggests that buspirone can be safely used for extended periods of time, and that the dose can be adjusted as needed 4, 5.
- It may be reasonable to restart treatment at the same dose (10 mg BID) if the patient previously tolerated it, but this decision should be made on a case-by-case basis, taking into account the individual patient's medical history and current condition 2, 3, 4, 5.