Recommended Starting Dose for Buspar (Buspirone)
Start buspirone at 5 mg twice daily (total 10 mg/day), then increase by 5 mg/day every 2-3 days until reaching the target therapeutic range of 15-30 mg/day in divided doses. 1
Initial Dosing Strategy
- Begin with 5 mg twice daily as the standard starting dose for adult patients with generalized anxiety disorder 1
- Titrate upward by 5 mg/day increments every 2-3 days based on tolerability 1
- The target therapeutic dose is 15-30 mg/day in divided doses, which represents the effective range for most patients 1, 2
- Maximum dose is 60 mg/day, though this is rarely needed 1
Critical Timing Expectations
Set realistic expectations with patients: buspirone requires 2-4 weeks for full therapeutic effect, making it inappropriate for acute anxiety requiring immediate relief 1. This delayed onset is a common reason for premature discontinuation and treatment failure 1.
- Do not assess treatment response before 2-4 weeks, as earlier evaluation will underestimate efficacy 1
- Patients seeking immediate relief or rapid symptom control are not ideal candidates for buspirone 3
Common Prescribing Pitfalls to Avoid
- Never start at too high a dose - this increases side effects without providing faster benefit 1
- Do not discontinue prematurely before the 2-4 week therapeutic window 1
- Buspirone is only useful for mild-to-moderate generalized anxiety, not for severe agitation or acute panic 1
- Studies in panic disorder have been inconclusive, so buspirone is not recommended for routine panic disorder treatment 3
Special Population Considerations
For elderly patients (≥65 years): Buspirone is preferred over benzodiazepines due to lack of sedation, cognitive impairment, and fall risk 1. The same starting dose of 5 mg twice daily applies, with a mean effective dose of 18 mg/day (range 5-30 mg/day) being well-tolerated 1.
For patients with hepatic or renal impairment: Dose reduction is warranted, as buspirone concentrations increase substantially in these populations 4.