What is the recommended dosing for Buspar (buspirone)?

Buspar (Buspirone) Dosing

Start buspirone at 5 mg twice daily (total 10 mg/day) and increase by 5 mg per day every 2-3 days until reaching the target dose of 15-30 mg/day divided into 2-3 doses, with a maximum of 60 mg/day. 1

Initial Dosing Strategy

• Begin with 5 mg twice daily (morning and evening) for the first few days 1
• This conservative starting approach minimizes side effects while establishing baseline tolerability 1
• The initial dose should be taken on an empty stomach or before meals for optimal absorption 2

Titration Schedule

• Increase by 5 mg per day every 2-3 days until therapeutic effect is achieved 1
• Most patients respond to 15-30 mg/day divided into 2-3 doses 1, 2
• The typical maintenance dosage range is 15-30 mg/day, which has been shown to be as effective as benzodiazepines in clinical trials 2, 3
• Maximum recommended dose is 60 mg/day (can be given as 20 mg three times daily) 1

Critical Timing Considerations

• Expect a 1-2 week lag time before onset of anxiolytic effect 2
• This delayed onset is fundamentally different from benzodiazepines and requires patient counseling to maintain compliance 2
• Patients must understand that immediate anxiety relief will not occur, unlike with benzodiazepines 2

Elderly Patients

• Use standard dosing (5 mg twice daily starting dose) but monitor more carefully for side effects 1
• The 5 mg twice daily starting dose is particularly appropriate for older adults 1
• No specific dose reduction is required based solely on age, but increased vigilance for adverse effects is warranted 1

Long-Term Use

• Chronic use for up to 52 weeks has been studied, with most patients successfully managed on 15-30 mg/day 3
• No withdrawal syndrome occurs with abrupt discontinuation after prolonged use (>6 months) 3
• When used for several months or longer, periodically reevaluate the need for continued therapy 3

Special Pharmacokinetic Considerations

• Food increases buspirone exposure 2-fold (both Cmax and AUC), so consistent timing relative to meals is important 4
• Renal impairment: Cmax and AUC increase 2-fold; consider dose reduction 4
• Hepatic impairment: Cmax and AUC increase 15-fold with doubled half-life; significant dose reduction required 4
• Drug interactions: Verapamil, diltiazem, erythromycin, and itraconazole substantially increase buspirone levels; rifampin decreases levels 10-fold 4

Common Pitfalls to Avoid

• Do not expect immediate anxiolytic effects - the 1-2 week lag time is inherent to buspirone's mechanism 2
• Do not use buspirone for acute anxiety relief - it is not appropriate for as-needed dosing 2
• Do not assume benzodiazepine-like properties - buspirone lacks sedative, hypnotic, anticonvulsant, and muscle relaxant effects 2
• Do not discontinue prematurely - patients may abandon therapy before the drug takes effect if not properly counseled 2

Advantages Over Benzodiazepines

• Minimal sedation compared to benzodiazepines, making it ideal when daytime alertness is critical 2
• No psychomotor or cognitive impairment in healthy volunteers 2
• No additive effects with alcohol 2
• Limited abuse and dependence potential 2, 3
• No withdrawal syndrome even after prolonged use 3