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 is based on the principle of "start low, go slow" in psychopharmacology, which helps optimize both tolerability and adherence to the medication regimen. 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 dose of 20 mg three times daily. Although the patient previously tolerated 10 mg BID, restarting at a lower dose allows the body to readjust to the medication after a prolonged absence, potentially reducing side effects like dizziness, headache, or nausea that can occur with immediate full dosing.
After starting at 7.5 mg BID, you can typically increase to the target dose of 10 mg BID after 3-7 days if the patient is tolerating the medication well. This cautious approach is particularly important because several years have passed since the patient last took buspirone, and their physiological response to the medication may have changed. The guidelines also highlight the importance of careful dosing and monitoring, especially in patients with a history of medication use, to minimize the risk of adverse effects and ensure optimal treatment outcomes.
Some key points to consider when restarting buspirone include:
- Starting with a lower dose to minimize side effects and allow the body to adjust to the medication
- Gradually increasing the dose as needed and tolerated by the patient
- Monitoring the patient closely for any adverse effects or changes in their condition
- Adjusting the dose or discontinuing the medication if necessary to ensure the patient's safety and well-being.
Overall, a gradual and cautious approach to restarting buspirone is recommended, taking into account the patient's individual needs and medical history, as well as the potential risks and benefits of the medication 1.
From the Research
Dosing Considerations for Buspirone
- The provided studies do not directly address the question of whether a patient who previously tolerated buspirone 10 mg twice daily (BID) can be restarted at the same dose after a few years, or if they should begin with 7.5 mg BID 2, 3, 4, 5, 6.
- However, the studies suggest that buspirone can be safely used for extended periods, with no evidence of a withdrawal syndrome or unusual events when therapy is discontinued after more than six months 2.
- The pharmacokinetics of buspirone in patients with renal or hepatic impairment have been evaluated, and the results suggest that steady state is reached after 3 to 5 days of dosing, regardless of renal or hepatic function 5.
- The efficacy and safety of two dosing regimens of buspirone (15 mg BID and 10 mg TID) have been compared in patients with persistent anxiety, and the results show no significant differences in efficacy or safety between the two treatment groups 3, 6.
Restarting Buspirone Therapy
- There is no clear guidance on whether a patient who previously tolerated buspirone 10 mg BID can be restarted at the same dose after a few years, or if they should begin with a lower dose such as 7.5 mg BID.
- However, the studies suggest that buspirone is generally well-tolerated, and the incidence of adverse events is similar between different dosing regimens 3, 6.
- It is possible that a patient who previously tolerated buspirone 10 mg BID may be able to restart at the same dose, but this decision should be made on a case-by-case basis, taking into account the individual patient's medical history and current health status 2, 5.