What is the recommended dosing for buspirone (anxiolytic medication)?

Buspirone Dosing for Anxiety

Start buspirone at 5 mg twice daily and titrate up to a typical maintenance dose of 15-30 mg/day, with a maximum of 60 mg/day (20 mg three times daily) if needed. 1

Initial Dosing

• Begin with 5 mg twice daily as recommended by the American Academy of Family Physicians 1
• This conservative starting dose minimizes initial side effects while establishing baseline tolerability 1

Titration and Maintenance

• Most patients are successfully managed on 15-30 mg/day divided into 2-3 doses 2
• The maximum recommended dose is 20 mg three times daily (60 mg total daily) 1
• Doses can be given either twice daily (BID) or three times daily (TID) with similar safety profiles 3
• BID dosing (15 mg twice daily) may improve compliance compared to TID regimens without compromising efficacy or safety 3

Critical Timing Consideration

• Therapeutic effects require 2-4 weeks to become evident 1
• This delayed onset is a common pitfall—patients must be counseled about this "lagtime" to prevent premature discontinuation 4
• Early studies noted 1-2 weeks minimum before anxiolytic effects appear 4
• Patient motivation and education about delayed response is essential to maintain compliance during the initial treatment period 1, 4

Dosing Adjustments for Special Populations

Hepatic Impairment

• Reduce dose significantly in hepatic impairment—plasma concentrations increase 15-fold and half-life doubles compared to healthy individuals 5
• Start at lower doses and titrate cautiously in this population 5

Renal Impairment

• Reduce dose in renal impairment—peak concentrations and drug exposure double compared to healthy volunteers 5

Food Effects

• Food increases buspirone absorption 2-fold (both peak concentration and total exposure) 5
• Administer consistently with or without food to maintain stable plasma levels 5

Drug Interactions Requiring Dose Adjustment

Significant dose reductions are necessary when buspirone is combined with:

• Verapamil or diltiazem—substantially increase buspirone plasma concentrations 1, 5
• Erythromycin or itraconazole—substantially increase buspirone levels 1, 5
• Rifampin decreases buspirone concentrations nearly 10-fold—may require dose increases or alternative therapy 5

Long-Term Use

• Buspirone can be safely used for up to one year when chronic anxiety treatment is necessary 2
• No withdrawal syndrome occurs with abrupt discontinuation after 6+ months of therapy 2
• Periodically reassess the need for continued anxiolytic therapy when treatment extends beyond several months 2

Common Side Effects

• Dizziness and headache are the most frequently reported adverse effects 1, 3
• Nausea occurs commonly but is generally mild 3
• Sedation is significantly less common than with benzodiazepines, making buspirone preferable when daytime alertness is important 4
• Palpitations occur more frequently with BID dosing (5%) versus TID dosing (1%) 3

Clinical Context

• Buspirone is most useful for mild to moderate anxiety 1
• Unlike benzodiazepines, buspirone has limited abuse potential and no muscle relaxant, anticonvulsant, or hypnotic properties 4
• The medication does not impair psychomotor or cognitive function and has no additive effects with alcohol 4