Buspirone is an anti-anxiety medication that can be used for chronic management. I’ll outline some of the most important clinical pearls and share some anecdotal education in this blog post.
The Good – Buspirone Clinical Pearls
Buspirone is well tolerated which is a nice advantage. In my geriatric practice, it represents an option that is much less likely to cause troublesome adverse effects in comparison to using benzodiazepines. Fall risk, confusion, CNS depression, and the risk for dependence are all less likely with buspirone compared to benzodiazepines.
What Do Patients Complain About?
Buspirone is typically well tolerated so that’s generally not the issue for most patients. The biggest challenge with buspirone is its half-life. The half-life of this medication is extremely short (2-3 hours) for a chronic management medication. This can negatively impact patient adherence as it needs to be given at least 2-3 times daily to maintain therapeutic concentrations.
Onset of Action
Buspirone is not going to work on an as-needed basis. This differs from agents like benzodiazepines. Much like SSRIs, buspirone is typically going to take a few weeks to show any benefit which can be frustrating for many patients who want their anxiety symptoms to be resolved quickly. I have seen this mistake a handful of times from clinicians (as well as show up on board exams). Buspirone should not be used on an as-needed basis because it is unlikely to have any benefit in the short term.
Less Risk For Sexual Dysfunction
SSRIs are the most commonly used class of agents for the initial management of anxiety when pharmacotherapy is indicated. There are potential side effects with this class and that includes sexual dysfunction/reduced libido. In patients with anxiety who experience this adverse effect from SSRIs, buspirone may represent an option with a lower incidence of this adverse effect.
There isn’t a ton of evidence for buspirone being used in other disease states. In practice, I have seen it used to augment antidepressants in the management of depression. There is some evidence that it may help modestly but in this study, it was generally outperformed by combining bupropion with an SSRI.
I have seen buspirone used for GI issues, but only a couple of times in my career. The body of evidence is not that strong to support its use but when we are running out of options, it might be a consideration. Here’s a case report of buspirone being used for refractory IBS.
What else would you add to your list of buspirone clinical pearls?
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