Is Buspirone on the Beers Criteria?
No, buspirone is not listed on the American Geriatrics Society Beers Criteria as a potentially inappropriate medication for older adults. 1, 2
Evidence from Beers Criteria Guidelines
The most recent 2023 AGS Beers Criteria update, along with the 2019 version, does not include buspirone among the approximately 30 individual medications or medication classes to avoid in older adults. 1, 3, 2 The criteria specifically list problematic anxiolytics and CNS agents—including benzodiazepines, nonbenzodiazepine hypnotics, and certain antidepressants—but buspirone is notably absent from these lists. 1, 3
FDA Safety Data in Older Adults
The FDA drug label provides reassuring data specifically for geriatric use: in a study of 6,632 patients receiving buspirone for anxiety, 605 patients were ≥65 years old and 41 were ≥75 years old, with safety and efficacy profiles similar to younger populations (mean age 70.8 vs 43.3 years). 4 The FDA notes that spontaneous adverse event reporting has not identified clinically significant differences between elderly and younger patients, though greater sensitivity in some older patients cannot be ruled out. 4
Importantly, age does not affect buspirone pharmacokinetics. 4
Critical Prescribing Considerations in Older Adults
Despite not being on the Beers Criteria, buspirone requires specific caution in certain geriatric populations:
Severe hepatic impairment: Buspirone cannot be recommended due to 13-fold increased steady-state AUC and prolonged half-life. 4
Severe renal impairment: Buspirone cannot be recommended due to 4-fold increased steady-state AUC in patients with creatinine clearance 10-70 mL/min/1.73 m². 4
Drug interactions: Buspirone is metabolized by CYP3A4, requiring dose adjustments when combined with strong CYP3A4 inhibitors or inducers. 4
Advantages Over Beers-Listed Alternatives
Buspirone offers distinct advantages compared to medications that ARE on the Beers Criteria:
Unlike benzodiazepines (which are on the Beers Criteria), buspirone has no significant affinity for benzodiazepine receptors and does not affect GABA binding. 4
Unlike benzodiazepines, buspirone is not associated with the high-risk CNS effects that increase cognitive impairment, delirium, falls, fractures, and motor vehicle accidents. 3
Buspirone does not carry the increased mortality risk associated with antipsychotics or the severe respiratory depression risk from opioid-benzodiazepine combinations. 3
Common Pitfalls to Avoid
Do not assume buspirone is risk-free: While not on the Beers Criteria, recent pharmacovigilance data identified safety signals including serotonin syndrome (n=83), drug interactions (n=86), and suicide-related events. 5
Screen for hepatic and renal function: The dramatic pharmacokinetic changes in organ impairment make baseline assessment mandatory before prescribing. 4
Monitor for CNS medication burden: Although buspirone itself is not problematic, combining it with multiple other CNS agents (antidepressants, antipsychotics, benzodiazepines, opioids, antiepileptics) increases fall risk. 3
Discontinue before catecholamine testing: Buspirone interferes with urinary metanephrine/catecholamine assays and must be stopped 48 hours before testing to avoid false-positive results for pheochromocytoma. 4