What is the efficacy of buspirone (an anxiolytic medication) for treating anxiety in the geriatric population?

From the Guidelines

Buspirone is a suitable medication for anxiety in the geriatric population, given its favorable side effect profile and minimal risk of dependence or cognitive impairment. The recommended initial dosage is 5 mg twice daily, which can be gradually increased to 15-30 mg daily in divided doses, as needed and tolerated 1. It's essential to note that buspirone may take 2-4 weeks to become fully effective, emphasizing the importance of patience and regular follow-up with patients.

Key Considerations for Buspirone Use in Geriatric Patients

• Buspirone is generally well-tolerated in older adults, with common side effects including dizziness, headache, and nausea, which are usually mild and transient.
• Unlike benzodiazepines, buspirone does not cause significant sedation, cognitive impairment, or dependence issues, making it a safer choice for geriatric patients who may be taking multiple medications.
• Buspirone's mechanism of action, affecting serotonin and dopamine receptors rather than enhancing GABA activity, contributes to its more favorable side effect profile for this population.
• Monitoring of blood pressure is recommended, as some patients may experience changes while on buspirone.

Comparison with Other Anxiolytic Options

• Benzodiazepines, although effective for anxiety, are associated with a higher risk of tolerance, addiction, depression, and cognitive impairment, especially in the elderly 1.
• Non-pharmacological approaches, such as cognitive behavioral therapy, should be considered alongside medication for the optimal management of anxiety in geriatric patients.

Given the available evidence, buspirone stands out as a reasonable and safer choice for managing anxiety in the geriatric population, especially when considering the potential risks associated with other anxiolytic medications like benzodiazepines 1.

From the FDA Drug Label

In one study of 6,632 patients who received buspirone for the treatment of anxiety, 605 patients were ≥ 65 years old and 41 were ≥ 75 years old; the safety and efficacy profiles for these 605 elderly patients (mean age = 70. 8 years) were similar to those in the younger population (mean age = 43. 3 years). Review of spontaneously reported adverse clinical events has not identified differences between elderly and younger patients, but greater sensitivity of some older patients cannot be ruled out. There were no effects of age on the pharmacokinetics of buspirone

Buspirone for Anxiety in Geriatric Population:

• The safety and efficacy profiles of buspirone in elderly patients (≥ 65 years old) were similar to those in the younger population.
• However, greater sensitivity of some older patients cannot be ruled out.
• No effects of age on the pharmacokinetics of buspirone were observed 2. It can be used for the management of anxiety disorder in the geriatric population, but with caution and careful monitoring for potential adverse effects.

From the Research

Buspirone for Anxiety in Geriatric Population

• Buspirone is considered an option for the treatment of anxiety in the geriatric population, particularly for relatively healthy older adults who want to avoid sexual side effects 3.
• Studies have shown that buspirone is effective in relieving moderate-to-severe symptoms of anxiety in elderly patients, with a similar side effect profile to that of younger patients 4, 5.
• Buspirone may be administered to patients aged 65 years or older without any special adjustment in dose, and it does not cause unusual adverse age-related phenomena 4.
• However, some studies suggest that buspirone may lack sufficient evidence to support its use in elderly populations, and it is not considered a first-line treatment for anxiety in this age group 6.
• Other treatment options for anxiety in the geriatric population include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other antidepressants, which are considered first-line treatments due to their efficacy and safety profiles 3, 6.
• Benzodiazepines and other sedative-hypnotic agents are generally not recommended for the treatment of anxiety in the elderly due to their potential for adverse effects and dependence 3, 6, 7.