Buspirone and Sertraline Dosing for Anxiety in Adults
For buspirone, start at 5 mg twice daily and titrate to 15-30 mg per day in divided doses; for sertraline, start at 25-50 mg daily and titrate up to 200 mg daily as needed. 1, 2
Buspirone (BuSpar) Dosing
Initial dosing: Begin with 5 mg twice daily, then increase by 5 mg per day every 2-3 days as tolerated 1
Target dose: 15-30 mg per day in divided doses for generalized anxiety disorder 1
Maximum dose: 60 mg per day if needed 1
Dosing schedule options:
- 15 mg twice daily (BID) or 10 mg three times daily (TID) are equally effective and safe 1, 3
- The traditional dosing is 10 mg three times daily, but twice daily dosing may improve compliance 4, 3
Critical Counseling Point for Buspirone
Buspirone requires 2-4 weeks to become effective - this is essential to communicate to patients to maintain compliance during the lag period before therapeutic benefit appears 1, 5
Buspirone Clinical Considerations
- Most appropriate for mild to moderate anxiety 1
- Most common side effects: dizziness, headache, nausea, nervousness, and lightheadedness 1, 4
- Does not cause sedation, muscle relaxation, or impair psychomotor function like benzodiazepines 5, 6
- No significant abuse potential or physiologic dependence 6
Sertraline (Zoloft) Dosing
Initial dose: 25-50 mg per day (can be given morning or evening) 2
Maximum dose: 200 mg per day 2
Titration: Increase gradually based on response and tolerability 2
Sertraline Clinical Advantages
- Well tolerated compared to other SSRIs 2
- Has less effect on metabolism of other medications compared to other SSRIs 2
- Typical SSRI side effects can include sweating, tremors, nervousness, insomnia or somnolence, dizziness, gastrointestinal disturbances, and sexual dysfunction 2
Common Pitfalls to Avoid
For buspirone: Patients may discontinue prematurely due to the 2-4 week delay in therapeutic effect - proactive counseling about this lag time is critical 1, 5
For sertraline: Side effects may not manifest for several weeks due to the drug's pharmacokinetics, so monitor patients beyond the initial titration period 2
Discontinuation: When stopping sertraline, taper over 10-14 days to limit withdrawal symptoms 2