From the Guidelines
Buspar (buspirone) can be a suitable medication for elderly patients with anxiety disorders, but it should be used with caution, prioritizing the patient's quality of life, morbidity, and mortality. For elderly patients, starting at a lower dose of 5 mg twice daily is recommended, with gradual increases if needed up to a maximum of 30 mg daily (divided into multiple doses) 1. Elderly patients may be more sensitive to side effects and often metabolize medications more slowly, necessitating these lower starting doses. Buspar is generally well-tolerated in older adults because it doesn't cause significant sedation, cognitive impairment, or dependence issues that are common with benzodiazepines. It also has minimal impact on blood pressure and heart rate, making it safer for those with cardiovascular concerns. However, Buspar takes 2-4 weeks to reach full effectiveness, which is important for patients to understand. Common side effects may include dizziness, headache, and nausea. Kidney or liver impairment in elderly patients may require further dose adjustments. Regular monitoring is essential, and patients should report any concerning side effects to their healthcare provider immediately.
Key Considerations
- Starting dose: 5 mg twice daily, with gradual increases as needed
- Maximum dose: 30 mg daily (divided into multiple doses)
- Common side effects: dizziness, headache, nausea
- Special considerations: kidney or liver impairment, cardiovascular concerns
- Time to full effectiveness: 2-4 weeks
Patient Education
Patients should be educated about the potential side effects of Buspar, including dizziness, headache, and nausea. They should also be informed about the importance of regular monitoring and reporting any concerning side effects to their healthcare provider. Additionally, patients should understand that Buspar takes 2-4 weeks to reach full effectiveness and that dose adjustments may be necessary based on individual response and tolerability.
Clinical Decision-Making
When prescribing Buspar to elderly patients, clinicians should prioritize the patient's quality of life, morbidity, and mortality. This involves careful consideration of the patient's medical history, current medications, and potential interactions. Clinicians should also be aware of the potential for polypharmacy and take steps to minimize the risk of adverse drug reactions and interactions 1. By taking a comprehensive and individualized approach to prescribing Buspar, clinicians can help ensure the safe and effective management of anxiety disorders in elderly patients.
From the FDA Drug Label
In one study of 6,632 patients who received buspirone for the treatment of anxiety, 605 patients were ≥ 65 years old and 41 were ≥ 75 years old; the safety and efficacy profiles for these 605 elderly patients (mean age = 70. 8 years) were similar to those in the younger population (mean age = 43. 3 years). Review of spontaneously reported adverse clinical events has not identified differences between elderly and younger patients, but greater sensitivity of some older patients cannot be ruled out. There were no effects of age on the pharmacokinetics of buspirone The safety and efficacy of buspirone in elderly patients are similar to those in younger patients, but greater sensitivity of some older patients cannot be ruled out 2.
- Key points:
- The safety and efficacy profiles of buspirone in elderly patients (≥ 65 years old) were similar to those in younger patients.
- There were no effects of age on the pharmacokinetics of buspirone.
- Greater sensitivity of some older patients to buspirone cannot be ruled out.
From the Research
Buspar in the Elderly
- Buspirone has been found to be effective in treating anxiety in elderly patients, with similar efficacy to that seen in younger patients 3, 4.
- A study published in the Journal of Clinical Psychopharmacology found that buspirone treatment resulted in significantly greater improvement on the Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Clinical Global Impression assessment than did placebo in elderly patients 3.
- Another study published in Clinical Therapeutics found that buspirone was safe and effective in treating anxiety in elderly patients, with no significant differences in side effects compared to younger patients 4.
- Buspirone has also been found to have a favorable side effect profile in elderly patients, with minimal effects on cognitive and psychomotor function 5.
Comparison to Other Treatments
- Buspirone has been compared to other anxiolytic medications, such as benzodiazepines, and has been found to have a more favorable side effect profile 6, 5.
- A study published in the Journal of Clinical Psychopharmacology found that buspirone was effective in treating anxiety in elderly patients, while alprazolam had minimal effects on cognitive and psychomotor function 5.
- However, it is worth noting that the evidence for buspirone's effectiveness in treating anxiety in elderly patients is not as extensive as that for other medications, such as selective serotonin reuptake inhibitors (SSRIs) 6.
Safety and Tolerability
- Buspirone has been found to be well-tolerated in elderly patients, with minimal side effects reported 3, 4.
- A study published in Clinical Therapeutics found that buspirone did not cause unusual adverse age-related phenomena in elderly patients 4.
- However, as with any medication, it is important to monitor elderly patients for potential side effects and interactions with other medications 3, 4.