Can Buspirone Cause Orthostatic Hypotension?
Buspirone is NOT associated with orthostatic hypotension and does not appear in any major guideline or systematic review as a causative agent for this condition.
Evidence Against Buspirone Causing Orthostatic Hypotension
Buspirone is conspicuously absent from comprehensive lists of medications that cause orthostatic hypotension. A 2021 systematic review and meta-analysis of 69 randomized controlled trials examining drug-induced orthostatic hypotension found that beta-blockers, tricyclic antidepressants, alpha-blockers, antipsychotics, and SGLT-2 inhibitors were associated with increased odds of orthostatic hypotension, but buspirone was not identified as a culprit 1.
Multiple authoritative guidelines on orthostatic hypotension management consistently identify specific medication classes as causative agents—including alpha-1 blockers, centrally-acting antihypertensives (clonidine, methyldopa), diuretics, vasodilators, phenothiazines, tricyclic antidepressants, and antipsychotics—but buspirone does not appear on these lists 2, 3, 4.
Mechanism and Pharmacology
Buspirone's mechanism of action makes orthostatic hypotension unlikely. The drug primarily acts on 5-HT1A receptors with some affinity for DA2 autoreceptors and 5-HT2 receptors, but it lacks the alpha-adrenergic blocking properties or significant cardiovascular effects that typically cause orthostatic hypotension 5. Unlike benzodiazepines and other anxiolytics, buspirone causes only minimal sedation and lacks muscle-relaxant properties 5.
The most common adverse effects of buspirone are headaches, dizziness, nervousness, and lightheadedness—but these symptoms are distinct from orthostatic hypotension and occur without postural blood pressure changes 5. The "dizziness" reported with buspirone is a central nervous system effect, not a cardiovascular phenomenon 6.
Clinical Implications
If a patient on buspirone develops orthostatic hypotension, look for other causes. The European Society of Cardiology identifies drug-induced autonomic failure as the most frequent cause of orthostatic hypotension, with diuretics and vasodilators being the most important culprits 2. Alpha-1 blockers, centrally-acting antihypertensives, antipsychotics, and tricyclic antidepressants are far more likely offenders 3, 4, 1.
Evaluate for volume depletion, neurogenic causes, endocrine disorders, and polypharmacy effects rather than attributing orthostatic hypotension to buspirone 2. In patients with multiple medications, consider that drugs targeting multiple parts of the orthostatic blood pressure reflex pathway carry cumulative risk 1.
Common Pitfall
Do not confuse the subjective complaint of "dizziness" with orthostatic hypotension. Patients with psychotic disorders and anxiety often report dizziness that does not correlate with actual orthostatic blood pressure changes 7. Buspirone can cause subjective dizziness as a central nervous system effect without causing postural hypotension 5, 6.