What is the dosing for Buspar (buspirone)?

From the Guidelines

Buspar (buspirone) should be initiated at a dose of 5 mg twice daily, with a maximum dose of 20 mg three times daily, as this dosing regimen has been shown to be effective in managing mild to moderate agitation 1.

Key Considerations for Buspar Dosing

• The initial dosage of 5 mg twice daily can be gradually increased as needed and tolerated, with most patients responding to a dose between 20-30 mg per day, divided into two or three doses.
• It is essential to note that buspirone may take 2 to 4 weeks to become effective, and patients should be advised to take the medication consistently, preferably at the same times each day.
• Food affects the absorption of buspirone, so it is recommended to take the medication either always with food or always without food to maintain consistent blood levels.

Special Populations

• Elderly patients or those with kidney or liver impairment may require a lower starting dose, usually 5 mg twice daily, and should be closely monitored for adverse effects.
• The maximum recommended daily dose of 60 mg should not be exceeded, and patients should not abruptly discontinue the medication.

Mechanism of Action

• Buspirone works by gradually modulating serotonin and dopamine receptors in the brain, which is why it takes 2-4 weeks to reach full therapeutic effect, unlike benzodiazepines which work immediately 1.

From the FDA Drug Label

When used in combination with a potent inducer of CYP3A4 the dosage of buspirone may need adjusting to maintain anxiolytic effect. The FDA drug label does not answer the question.

From the Research

Buspar Dosing Information

• The typical dosing regimen for buspirone (BuSpar) is 15 mg twice daily (BID) or 10 mg three times daily (TID) 2, 3.
• Studies have shown that both BID and TID regimens are effective in treating anxiety, with no significant differences in efficacy between the two regimens 2, 3.
• The dose of buspirone can be titrated from 15 mg/d to 30 mg/d, with some studies using a dose of 30 mg/d as either a BID or TID regimen 2, 4, 3.
• One study used a dose of 30 mg/daily (10 mg three times a day) for 6 weeks in the treatment of panic disorder 4.
• Another study used a dose of buspirone or placebo, combined with anxiety management training or non-directive therapy for a period of 8 weeks, with a mean Hamilton Anxiety Scale score of 28 5.

Adverse Events and Safety

• The incidence of adverse events was similar between the BID and TID treatment groups, except for a significantly greater incidence of palpitations in patients receiving buspirone BID (5%) compared to buspirone TID (1%) 2.
• The most frequently reported adverse events for both buspirone BID- and TID-treated patients were dizziness, headache, and nausea 2.
• One study found a significantly greater incidence of amblyopia in patients receiving buspirone 15 mg BID 3.

Clinical Implications

• A short course of psychological therapy, whether or not accompanied by active medication, was an effective treatment for patients diagnosed as having quite severe symptoms of generalized anxiety disorder (GAD) 5.
• The combined therapy of panic disorder with buspirone and cognitive-behavioral therapy is an optimal treatment, though not without the limitations of short-term methods 4.