What is the starting dose of Buspar (buspirone) for an adult patient with anxiety?

Buspar Starting Dose for Adult Anxiety

Start buspirone at 5 mg twice daily (10 mg/day total) and 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 Protocol

• 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 clinical response 1
• The target therapeutic dose range is 15-30 mg/day given in divided doses (typically twice or three times daily) 1, 2, 3
• Maximum dose is 60 mg/day, though this is rarely necessary 1

Critical Timing Expectations

• Buspirone requires 2-4 weeks for full therapeutic effect, making it inappropriate for acute anxiety requiring immediate relief 1
• Do not assess treatment response or discontinue therapy before completing at least 2-4 weeks of treatment 1
• Some studies note a "lag time" of 1-2 weeks before anxiolytic effects become apparent, so patient motivation and compliance counseling is essential 2

Common Prescribing Pitfalls to Avoid

• Do not 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 has elapsed 1
• Buspirone is only effective for mild-to-moderate generalized anxiety, not for severe agitation or acute panic attacks 1

Food Effects and Administration

• Administer consistently with regard to food, as taking buspirone with food doubles both peak concentration and overall drug exposure 4
• The drug should be given in divided doses (typically 2-3 times daily) due to its short 2.5-hour elimination half-life 4, 5

Special Population Considerations

• Elderly patients: Buspirone is preferred over benzodiazepines due to lack of sedation, cognitive impairment, and fall risk, with effective doses of 5-30 mg/day (mean 18 mg/day) 1
• Hepatic impairment: Drug exposure increases 15-fold; dose reduction is necessary 4
• Renal impairment: Drug exposure doubles; dose reduction is warranted 4

Long-Term Use

• Most patients are successfully managed on 15-30 mg/day for chronic treatment 3
• Long-term use up to one year has demonstrated no withdrawal syndrome, abuse potential, or emergence of new adverse effects when discontinued 3