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 target dose of 15-30 mg/day in divided doses, with a maximum of 20 mg three times daily (60 mg/day total). 1

Initial Dosing

• Begin with 5 mg twice daily as recommended by the American Academy of Family Physicians 1
• Titrate gradually from the starting dose of 15 mg/day (5 mg three times daily) up to 30 mg/day based on clinical response 2
• Most patients are successfully managed on 15-30 mg/day in divided doses 3

Dosing Schedules

Both twice-daily and three-times-daily regimens are equally effective:

• 15 mg twice daily (BID) or 10 mg three times daily (TID) for a 30 mg total daily dose show equivalent efficacy and safety 4, 2
• The BID regimen may offer better convenience and compliance without compromising efficacy 4
• The only notable difference is a slightly higher incidence of palpitations with BID dosing (5% vs 1%) 4

Maximum Dosing

• Maximum recommended dose is 20 mg three times daily (60 mg total daily dose) 1
• Doses up to 90 mg/day have been studied and found safe and well-tolerated in major depression, though this exceeds standard anxiety dosing 5

Critical Timing Consideration

Counsel patients that therapeutic effects require 2-4 weeks to become evident 1. This delayed onset is a common pitfall—patients may discontinue prematurely if not properly educated. Some studies note a 1-2 week "lagtime" before anxiolytic effects appear 6.

Clinical Indications

• Buspirone is appropriate for mild to moderate anxiety/agitation 1
• Effective in generalized anxiety disorder (GAD) with symptom duration of at least 4 weeks 2

Important Drug Interactions

Significant increases in buspirone plasma concentrations occur with:

• Verapamil 1
• Diltiazem 1
• Erythromycin 1

Consider dose reduction when co-administering these medications.

Common Adverse Effects

The most frequent side effects include:

• Dizziness 1, 4
• Headache 1, 4
• Nausea 4

Notably, sedation occurs much less frequently than with benzodiazepines 6, making buspirone preferable when daytime alertness is important.

Long-Term Use

• Buspirone can be safely used for up to one year when chronic anxiety treatment is necessary 3
• No withdrawal syndrome occurs upon abrupt discontinuation after more than 6 months of therapy 3
• Periodically reevaluate the need for continued anxiolytic therapy when used for several months or longer 3