Maximum Daily Dose of Buspirone for High Anxiety
The maximum recommended daily dose of buspirone is 60 mg per day, typically administered as 20 mg three times daily. 1, 2, 3
Dosing Algorithm
Starting Dose
- Begin with 5 mg twice daily (10 mg/day total) for most adult patients 1, 2
- Alternative starting approach is 7.5 mg twice daily, though the lower dose is more commonly recommended 2, 3
- For elderly or frail patients, start lower at 2.5-5 mg twice daily and titrate more gradually 1, 2
Titration Schedule
- Increase by 5 mg increments every 2-3 days as tolerated until therapeutic effect is achieved 1, 2, 3
- The standard therapeutic range is 15-30 mg per day in divided doses 1, 4
- Most patients are successfully managed on 15-30 mg/day 4
Maximum Dosing
- Absolute maximum: 60 mg per day (20 mg three times daily) 1, 2, 3
- This maximum applies to high anxiety patients and should not be exceeded 3
Critical Timing Considerations
Buspirone requires 2-4 weeks for onset of action, with full therapeutic trials requiring 4-8 weeks before determining efficacy 1, 2. This delayed onset is a common pitfall—patients must be counseled upfront to maintain compliance and avoid premature discontinuation 1.
Special Population Adjustments
Hepatic Impairment
- Substantially reduce the dose in patients with liver disease 1
- Pharmacokinetic data show 15-fold higher drug exposure and doubled half-life in hepatic impairment 5
Renal Impairment
- Use lower doses and titrate cautiously 1
- Drug exposure doubles in renal impairment compared to healthy individuals 5
Elderly Patients
- Start at 2.5-5 mg twice daily 1, 2
- Titrate more gradually than younger patients 1
- However, elderly patients achieve similar anxiety relief at similar doses (mean 18 mg/day) as younger patients and tolerate the medication well 6, 7
Important Clinical Considerations
Food Effects
- Buspirone bioavailability increases 2-fold when taken with food 3, 5
- Patients should take buspirone consistently—either always with food or always without food 3
Drug Interactions
- Potent CYP3A4 inhibitors (verapamil, diltiazem, erythromycin, itraconazole) substantially increase buspirone plasma concentrations 3, 5
- When combined with CYP3A4 inhibitors, reduce buspirone dose accordingly 3
- Rifampin decreases buspirone concentrations nearly 10-fold 5
MAOI Interactions
- Allow at least 14 days between discontinuing an MAOI and starting buspirone, and vice versa 3
- Do not start buspirone in patients receiving reversible MAOIs (linezolid, IV methylene blue) due to serotonin syndrome risk 3
Long-Term Use
Buspirone has been studied for up to one year of continuous use without emergence of new safety concerns or withdrawal syndrome upon abrupt discontinuation 4. However, when used for several months or longer, periodically reevaluate the need for continued therapy 4.