Buspirone: What to Know About This Anxiety Medicine

What buspirone is

Buspirone is a tablet that MedlinePlus places in a class of medicines called anxiolytics. It is sold in the United States as a generic. It is chemically and practically different from benzodiazepines: the FDA label says it has no significant affinity for benzodiazepine receptors, lacks their prominent sedative effect, and does not have anticonvulsant or muscle relaxant effects.

One review places it in a group called azapirones and describes it as a partial agonist at a serotonin receptor known as 5-HT1A. You can compare it with others on our medicines list or read more about anxiety medicines other than benzodiazepines.

What it is approved for, and what the label leaves open

The FDA label says buspirone is indicated for the management of anxiety disorders or the short-term relief of the symptoms of anxiety. It also says that anxiety or tension from the stress of everyday life usually does not call for an anxiety medicine.

Its effectiveness was shown in controlled trials of outpatients whose diagnosis roughly corresponded to generalized anxiety disorder. Many of those people also had some depressive symptoms, and anxiety improved despite them. The label is not an approval for depression.

The label is candid about length of use: effectiveness beyond 3 to 4 weeks has not been shown in controlled trials. It adds that a prescriber who uses it for longer should check from time to time whether it is still useful for that person.

MedlinePlus says it is sometimes prescribed for other uses but names none, so we do not list any off-label uses here.

How it is thought to work

The honest answer is that nobody knows exactly. The label says the mechanism of action is unknown. Laboratory work shows it binds strongly to serotonin 5-HT1A receptors and moderately to dopamine D2 receptors, and it may affect other brain signaling systems indirectly. MedlinePlus puts it simply: it works by changing the amounts of certain natural substances in the brain.

What taking it can be like

Buspirone is generally described as gradual. One review describes an onset of around 10 days to 4 weeks, and MedlinePlus says it may take several weeks to reach a dose that works for you. That is different from a medicine that is felt soon after a single tablet, so it helps to ask your prescriber what to expect and when to check in.

The label gives a few everyday instructions. It asks people to take it consistently, either always with food or always without it, because food changes how much reaches the blood. It also says to avoid large amounts of grapefruit juice. Your prescriber and pharmacist can explain the directions for your prescription.

If you are taking a benzodiazepine or another sedative now, tell your prescriber. The label says buspirone does not block the withdrawal that can come with coming off those medicines, so it is not a stand-in for tapering under medical care.

Side effects and warnings

Buspirone has no boxed warning on its label. It does carry important cautions, and the first is about other medicines.

• MAOIs: use with an MAOI intended to treat depression, or within 14 days of stopping either medicine, is contraindicated because of the risk of serotonin syndrome or high blood pressure. Starting it while someone is being treated with linezolid or intravenous methylene blue is also contraindicated.
• Serotonin syndrome: this potentially life-threatening reaction has been reported, particularly with other serotonin medicines. Signs can include agitation, hallucinations, fast heartbeat, fever, sweating, muscle stiffness or twitching, and nausea or diarrhea. Get emergency help if these appear.
• Common side effects: the label lists dizziness, nausea, headache, nervousness, lightheadedness and excitement. MedlinePlus also lists trouble sleeping, fatigue and weakness.
• Restlessness: a syndrome of restlessness soon after starting has been reported in a small share of people. The label also says a question has been raised about movement effects because it binds dopamine receptors, though its trials did not find significant effects of that kind.
• Driving and alcohol: the label says to avoid driving or using complex machinery until you know how it affects you, and that it is prudent to avoid alcohol.
• Allergy: people who are hypersensitive to buspirone should not take it.

Dependence, pregnancy and changing course

The label says buspirone is not a controlled substance, and that human and animal studies showed no potential for abuse and no evidence of tolerance or physical or psychological dependence.

Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding, and share every medicine and supplement you use. MedlinePlus advises getting your doctor's or pharmacist's advice before starting, stopping or changing any medicine while taking buspirone.

Can buspirone be managed online in Pennsylvania and New York

Nothing in the label requires buspirone to be given in a clinic, and it is not a controlled substance, so the federal telemedicine rules for controlled medicines do not come into it. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication inquiry form.

A licensed psychiatrist on our team treats anxiety by secure video for people physically located in Pennsylvania or New York during each visit. Read more about online anxiety treatment or online psychiatry in New York. Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. Ask us about fees and insurance.

If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.