Buspirone TID Dosing Conversion and Administration Schedule
Increase from 10 mg once daily in the morning to 10 mg three times daily (TID), with doses administered at 8 AM, 12 PM (noon), and 4 PM in the inpatient setting. 1
Recommended Dosing Schedule
The FDA-approved initial dose for buspirone is 15 mg daily, typically given as 7.5 mg twice daily, with dose increases of 5 mg per day at intervals of 2-3 days as needed. 1 However, when converting your patient from 10 mg once daily to TID dosing:
- First dose: 8 AM (with morning medications) 2
- Second dose: 12 PM (noon/lunchtime) 2
- Third dose: 4 PM (late afternoon) 2
This timing ensures consistent drug levels throughout the waking hours while avoiding evening administration that could interfere with sleep. 3, 4
Dose Titration Strategy
Start with 10 mg TID (30 mg total daily dose) rather than maintaining the current 10 mg daily. 2, 1 This represents the standard therapeutic target dose range. 2, 5
Titration Timeline:
- Allow 2-4 weeks at 30 mg/day (10 mg TID) before further dose adjustments to assess therapeutic response, as buspirone has a characteristic 1-2 week "lagtime" to onset of anxiolytic effect. 2, 5, 4
- If inadequate response after 2-4 weeks at 30 mg/day, increase to 15 mg TID (45 mg/day total). 2, 1
- Maximum dose: 20 mg TID (60 mg/day total). 2, 1
Critical Clinical Considerations
Food Consistency Requirement:
Buspirone must be taken consistently either always with food or always without food at each dose, as food increases bioavailability approximately 2-fold. 1, 3 In the inpatient setting, coordinate with meal times or establish a consistent pattern independent of meals.
Common Pitfall to Avoid:
Do not increase doses too rapidly. The 1-2 week lagtime to therapeutic effect means premature dose escalation leads to unnecessarily high doses and increased side effects without additional benefit. 2, 5 Patient and staff education about this delayed onset is essential for medication compliance.
Monitoring Parameters:
- Assess for dizziness, headache, and nausea (most common adverse effects) at each dose level. 6
- Monitor for sedation, though this occurs much less frequently than with benzodiazepines. 5, 4
- Buspirone does not cause psychomotor impairment or have abuse potential, making it safer in the inpatient setting. 5, 4
Pharmacokinetic Rationale:
Buspirone has an elimination half-life of approximately 2.5 hours with the immediate-release formulation, necessitating TID dosing for consistent anxiolytic effect throughout the day. 3, 4 The short half-life explains why divided dosing (TID) provides more stable plasma concentrations than once-daily administration.