What can be done about jittery feelings caused by Buspar (buspirone)?

Managing Jittery Feelings from Buspar (Buspirone)

If buspirone is causing jittery feelings, reduce the dose immediately or discontinue the medication and consider switching to an alternative anxiolytic, as nervousness and lightheadedness are recognized adverse effects that may not resolve with continued use. 1, 2

Understanding the Side Effect

Nervousness and jittery feelings are among the most common adverse effects of buspirone:

• Headaches, dizziness, nervousness, and lightheadedness are the most frequently reported side effects in clinical practice 2
• The FDA label documents "nervousness" as a recognized adverse reaction, along with dream disturbances and other CNS effects 1
• These symptoms can occur even at therapeutic doses and may persist rather than resolve with continued treatment 2, 3

Immediate Management Strategy

Dose Reduction Approach

• Start by reducing the current dose by 5 mg per day to see if symptoms improve while maintaining some anxiolytic benefit 1
• Buspirone is typically dosed at 15-30 mg daily in divided doses, so there is room for downward titration 2, 4
• If the patient is already on a low dose (7.5 mg twice daily), dose reduction may not be feasible and discontinuation should be considered 1

Timing and Food Considerations

• Ensure consistent administration with regard to food - buspirone should always be taken either with food or without food, not alternating, as bioavailability increases significantly when taken with food 1
• Inconsistent timing relative to meals can cause fluctuating drug levels that may worsen jittery feelings 1

Alternative Anxiolytic Options

If dose reduction fails or symptoms are intolerable:

• Buspirone lacks the rapid onset that some patients expect from anxiolytics, with a typical "lag time" of 1-2 weeks to achieve full anxiolytic effect 4, 3
• The jittery feeling may reflect the drug's complex serotonergic and dopaminergic effects, which differ fundamentally from benzodiazepines 2, 5
• Consider switching to a different anxiolytic class if the patient cannot tolerate buspirone's side effect profile 4

Critical Safety Considerations

Rule Out Serotonin Syndrome

• Assess for other serotonergic medications that could be contributing to the jittery sensation, as buspirone can cause serotonin syndrome when combined with other serotonergic agents 1
• Look for additional symptoms beyond jitteriness: agitation, tremor, hyperreflexia, diaphoresis, tachycardia, or mental status changes 1
• If serotonin syndrome is suspected, discontinue buspirone immediately and provide supportive care 1

Medication Interactions

• Verify the patient is not taking MAOIs, as this combination is contraindicated and can cause dangerous elevations in blood pressure 1
• At least 14 days must elapse between stopping an MAOI and starting buspirone, or vice versa 1

Common Pitfalls to Avoid

• Do not assume the jittery feeling will resolve with time - while some side effects may diminish, nervousness is a persistent adverse effect for many patients 2, 3
• Do not increase the dose thinking it will help - higher doses (up to 60 mg/day maximum) are more likely to worsen CNS side effects 1
• Do not combine with benzodiazepines without clear rationale - patients switching from benzodiazepines may misinterpret the lack of immediate sedation as "jitteriness" when it's actually the absence of the sedative effect they're accustomed to 4, 3

Patient Counseling Points

• Buspirone is fundamentally different from benzodiazepines and lacks sedative properties, which some patients interpret as feeling "activated" or jittery 2, 5
• The medication works gradually over 1-2 weeks, and immediate relief should not be expected 4, 3
• If jittery feelings are intolerable, this medication may simply not be appropriate for this patient, as buspirone is best suited for patients who can tolerate a slower, more gradual onset of anxiety relief 4