Buspirone hydrochloride

How it works

It is a partial agonist at 5-HT1A serotonin receptors, modulating serotonergic neurotransmission to produce anxiolysis without significant sedative, muscle-relaxant or dependence-forming effects.

Prescribing in practice

• Its anxiolytic effect develops gradually over weeks, so it is unsuitable for acute anxiety or 'as required' relief and patients should be told not to expect an immediate benefit.
• It does not prevent or treat benzodiazepine withdrawal, so a patient being switched from a benzodiazepine still needs that drug tapered separately.
• Avoid concurrent monoamine oxidase inhibitors and use caution with other serotonergic agents because of the risk of hypertensive or serotonergic reactions.

Monitoring

Monitor anxiety symptom response and tolerability over the first few weeks of treatment.

Counselling the patient

• This medicine takes a couple of weeks to start working, so keep taking it regularly rather than only when anxious.
• Avoid grapefruit juice, which can raise the amount of drug in your body.
• Report severe headache or feeling very agitated.

Evidence & guidelines

Buspirone is an established option for generalised anxiety disorder, distinct from benzodiazepines in lacking dependence liability.