Buspar (Buspirone) Contraindications
Buspar is absolutely contraindicated in patients with hypersensitivity to buspirone, those currently taking or who have taken MAOIs within 14 days, and those requiring treatment with reversible MAOIs like linezolid or intravenous methylene blue. 1
Absolute Contraindications
Hypersensitivity to buspirone hydrochloride - Any patient with known allergic reactions to the drug should not receive it 1
Concurrent MAOI use or recent discontinuation - The use of MAOIs intended to treat depression with buspirone or within 14 days of stopping buspirone is contraindicated due to increased risk of serotonin syndrome and/or elevated blood pressure 1
Starting buspirone within 14 days of stopping an MAOI - This timing restriction applies to all MAOIs used for depression 1
Reversible MAOIs (linezolid, intravenous methylene blue) - Starting buspirone in patients being treated with these agents is contraindicated due to serotonin syndrome risk 1
Critical Warnings Requiring Immediate Action
Serotonin syndrome is a potentially life-threatening condition that can develop when buspirone is combined with other serotonergic drugs, particularly MAOIs, SSRIs, SNRIs, triptans, or serotonin precursors like tryptophan 1. Symptoms include mental status changes (agitation, hallucinations, delirium, coma), autonomic instability (tachycardia, labile blood pressure, hyperthermia), neuromuscular changes (tremor, rigidity, myoclonus), seizures, and gastrointestinal symptoms 1.
If serotonin syndrome occurs, discontinue buspirone and all serotonergic agents immediately and initiate supportive symptomatic treatment 1
Elevated blood pressure has been reported when buspirone is added to regimens including MAOIs 1
Special Circumstances Requiring Caution
When Reversible MAOIs Are Necessary
If you must initiate linezolid or intravenous methylene blue in a patient taking buspirone, discontinue buspirone before starting the reversible MAOI 1. Note that all methylene blue reports involved intravenous administration at doses of 1-8 mg/kg; no reports exist for oral or local tissue injection routes 1.
Concomitant Serotonergic Drug Use
Triptans (5-HT receptor agonists) - If clinically warranted, use with careful observation, particularly during treatment initiation and dose increases 1
Serotonin precursors (tryptophan) - Concomitant use is not recommended 1
Antipsychotics and antidopaminergic agents - Monitor closely for serotonin syndrome when used together 1
Important Clinical Considerations
Buspirone has no established antipsychotic activity and should never be used as a substitute for appropriate antipsychotic treatment 1.
The drug undergoes extensive first-pass metabolism with only 4% bioavailability 2, 3, and its pharmacokinetics are significantly altered by hepatic and renal impairment 2. While these conditions are not absolute contraindications per FDA labeling, they warrant dose adjustments and careful monitoring.