Buspirone

Buspirone is a safe, non-addictive medication that is especially useful for people with anxiety and substance use disorders.

Buspirone – also known by its brand name Buspar – is an older synthetic medication that has made a comeback as an effectivetreatment for generalized anxiety disorder. Buspirone is also known for its recently identified potential for treating some addictions.

According to theNational Institute on Drug Abuse, roughly half of people with mental health disorders are dependent on addictive drugs or alcohol at some point in life.Depressionandanxietyare the most commondual diagnosismental health disorders that co-occur with addiction. That is why the discovery that buspirone may be useful for treating some mental health disorders and addiction makes this medication especially intriguing.

Research into buspirone’s use for treating substance use disorders is still preliminary, and much of it has only been done in animal studies. There may never be a drug that “treats” addiction. At best, medications can block some of the effects of drugs, or lessen withdrawal symptoms. The answer totreating addictionslies in identifying and addressing all the underlying causes of substance use disorder, such as poor coping skills, undiagnosed or untreated mental health disorders or past trauma.

What Is Buspirone?

Buspirone is an anti-anxiety medication that isin its own class; it is not related to the other available types of anti-anxiety medications (such as benzodiazepines, SSRIs, or barbiturates).

Buspirone is a drug that historically fell out of favor and was seldom used, but has been making a strong comeback due to its effectiveness, non-addictive properties, lack of withdrawal effects, safety and recently identified uses for treating addiction.

Buspirone affects the brain’s dopamine, the feel-good brain chemical (neurotransmitter) that is stimulated by addictive drugs and behaviors. As such, intense research into theuse of buspirone for treating addictionhas resurrected interest in this older drug.

Unlike some other anxiety medications, buspirone doesn’t cause physical or psychological dependence or result in a tolerance orwithdrawal symptomsassociated with other addictive substances. Buspirone is not a controlled substance, and has no known potential for abuse. However, there is always the potential for individuals to misuse the drug.

Background & History

Buspirone wasfirst made in the laboratoryin 1968, patented for medical use in 1975 and received FDA approval for use in treating generalized anxiety disorder in 1986. It was originally developed as atreatment for psychosis, but it was found to work very well for treating anxiety, which became its main use.

Use in Treating Anxiety

Buspirone has recently come back into favor as an anti-anxiety medication because of its favorable side effect profile and non-addictive properties compared to some other medication options. It is used mostly for treatinggeneralized anxiety disorder, and is usually used as a second-line option afterselective serotonin re-uptake inhibitors(SSRIs), the usual first choice for treating anxiety.

Buspirone is also being investigated for possible effectiveness in treating anxiety in people who have coexisting depression.

How Does Buspirone Work?

Despite being a relatively old medication, details of how buspirone works are still being uncovered. However,the reason for its positive effects for treating some addictionsis well known. Drugs and addictive behaviors give their “high” by increasing various chemical messengers in the brain (neurotransmitters), most especially dopamine.

Dopamine is part of the brain’s “reward system” that gives people pleasure when they accomplish something good (such as getting a raise at work), rewards them for behaviors that support survival (such as eating a good meal), and encourages them to do life-sustaining behaviors (such as procreating). When the brain wants to provide a reward, it gives a little shot of dopamine, and the result is feeling good for a little while.

Most addictive drugs andaddictive behaviorsgive people a “high” by stimulating the brain to produce abnormally large amounts of dopamine all at once, making people feel very good for a short time. This “reward” reinforces the drug use or behavior, and addiction develops.

When the brain releases dopamine, the chemical has to bind to a dopamine receptor in order to have its desired reward effect. It turns out that buspironeblocks those dopamine receptorsso that the drugs or behaviors don’t produce the high.

Use in Addiction Treatment

Studies have identified a significant impact of buspirone in reducing the addictive effects of nicotine alone, and nicotine along with cocaine use. Nicotine and cocaine are known to enhance each other’s addictive properties when they are taken together.

Asmall studyfound that buspirone was as effective as using a taper of the opioid-replacement drug methadone for alleviating withdrawal symptoms in people who are detoxing from opioid use. This is especially significant because, unlike methadone, buspirone has a safe side effect profile, no abuse potential, is a non-opioid and has no withdrawal symptoms. The U.S. National Institute on Drug Abuse (NIDA) iscurrently running clinical trialson this potentially valuable use of buspirone.

Another recent study found that buspirone effectively inhibited alcohol intake, which suggests that it will likely become a useful adjunct fortreating alcohol use disorderin the near future.

A large study of the effects of buspirone for co-occurring alcohol use disorder and anxiety (a common combination) shows that the drug is useful for treating anxiety in this situation. This is especially significant, because the usual anti-anxiety medications may increase alcohol use. Untreated anxiety can increase alcohol use and vice-versa.

However, buspirone is not useful for all substance use disorders. One study showed that it did no better (maybe even worse) than placebo for cannabis dependence. This is probably because cannabis has different neurotransmitter activity than most other addictive drugs.

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Taking Buspirone

Buspironecomes as a tabletand is available in 5mg, 7.5mg, 10mg, 15mg and 30mg doses. It is usually taken twice a day, and at a starting dosage of 7.5mg twice a day. The medication is titrated to find the optimal dose, usually by increasing the dose by 5mg per day every two or three days.

Buspirone can be taken with or without food, but should be taken the same way every time.

Because buspirone is not related to and works differently thanbenzodiazepine medications, it is not effective for treating withdrawal from benzodiazepine use, and may not work optimally in people who were recently treated with benzodiazepines.

What Happens If You Miss a Dose?

People who miss a dose of buspirone should contact their prescriber or pharmacist for advice. Generally, it is appropriate to take the missed dose as soon as it is remembered, unless it is near the time for the next dose, in which case skipping the missed dose and resuming taking it on the regular schedule would be appropriate. You should not typically double-dose.

How Long Does it Take for Buspirone to Work?

Buspirone does not work immediately to relieve acute anxiety like benzodiazepine medications. In fact, it can take2–4 weeksfor it to build up in the body enough to start working. It is approved for short-term and long-term use. Buspirone has a short elimination half-life of only 2.8 hours, so the body metabolizes the drug very quickly.

Effectiveness of Buspirone

Data on the effectiveness of buspirone for anxietyis limited. Because it is an older drug, it cannot be patented, and pharmaceutical companies have no financial incentive to conduct clinical trials. There is no data comparing buspirone’s effectiveness to othertreatments for anxiety.

Likewise, data for the effectiveness of buspirone in treating various substance use disorders is lacking, as science is still in the early stages of conducting proper research on this new indication for the drug.

Side Effects of Buspirone

Some people who take buspirone for anxiety stop taking it because of intolerableside effects. They attribute the discontinuation to various adverse effects, including:

• Dizziness
• Insomnia
• Lightheadedness
• Drowsiness
• Nervousness
• Headache
• Fatigue
• Nausea

Some other buspirone side effects that are also known to occur are:

• Shaking
• Numbness and tingling
• Fatigue and weakness
• Aches and pains
• Dry mouth
• Poor concentration
• Anger or hostile outbursts
• Blurred vision
• Rash
• Ringing in the ears
• Chest pain

This is not a complete list of the potential side effects of buspirone. Anyone taking this medication should review the risks of taking the medication with their prescriber. Side effects can sometimes be lessened by a slow and gradual dose increase when starting out on the drug.

Possible Interactions

Buspirone has warnings and known interactions with a number of medications, and should not be taken with some types of drugs. It is important that people make sure their prescriber is aware of all medications they take, including over-the-counter medications, herbal and health food supplements, and alcohol and illicit drugs.

There areunsafe interactionsof buspirone and alcohol that people taking the drug should be aware of.

Taking Buspirone While Pregnant

Animal studies have shown no evidence of effects of buspirone on fertility or on the normal development of the fetus. Buspirone should only be used during pregnancy if it is clearly necessary and under a doctor’s guidance.

Buspirone is excreted in breast milk, so it should be avoided for nursing mothers.

Alternatives to Buspirone

Buspirone is a unique medication, so there are no other choices in the same class to use as an alternative. However, there are alternatives from different classes of medications that can be used instead of (or sometimes in conjunction with) buspirone.

For example, there are a number of medication choices for treating anxiety disorders, as well as a number of non-medication options, such ascognitive behavioral therapy(CBT).

When it comes to treating addiction, research is quickly accumulating evidence of the benefits of the use of buspirone, but there are other medications currently available to treat substance use disorders, including withdrawal symptoms and co-occurring mental health disorders. However, addiction is never “cured” or “fixed” by medications; rather, it requires acomprehensive approachto addressing all the underlying causes and effects of the addiction.

What to Do In Case of Overdose

No deaths have been reported from an overdose with buspirone on its own. Doses as high as 375mg per day have been tested (compared to the starting dose of 15 mg per day), which produced negative side effects (dizziness, nausea, blurred vision, drowsiness), but no deaths.

In the event of an overdose on buspirone or other medications, call 911 and follow their instructions. Overdose with buspirone requires emergency hospital care. As with any overdose, the underlying reasons for the event should be identified and treated, especially if it was a suicide attempt.

Get More Information on Buspirone

Good, non-commercial, verifiable sources of information on buspirone can be found at a variety of government resources, including:

• FDA web page on BuSpar
• U.S. National Library of Medicine web page on Buspirone
• U.S. National Library of Medicine MedLinePlus – Buspirone

If you or someone you know is struggling with addiction to a prescription medication or illicit substance,contact The Recovery Villageto learn more treatment options.