Pharm
Buspar
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Buspar
, Buspirone
Mechanism
Azapirone modulates
Serotonin
transmission
Dosing
Start: 7.5 mg PO bid (or 5 mg PO tid)
Effective dose: 20 to 30 mg per day
Maximum: 60 mg per day
Indications
Anxiety Disorder
s
Generalized Anxiety Disorder
Chronic
Anxiety Disorder
Anxiety in the elderly
Aggression in developmentally disabled
Agitated
Dementia
Emotional behavioral problems in brain injury
Geriatric Depression
Adjunctive use with
SSRI
in
Major Depression
Mixed anxiety and depression
Enhance
Major Depression
response to
SSRI
Antidepressant Induced Sexual Dysfunction
Alcohol Withdrawal
Reduces anxiety of "needing" a drink
Obsessive Compulsive depression
Use Buspar with
Prozac
Decreases
Neuroleptic
adverse effects
Reduces
Tardive Dyskinesia
Reduces
Akathisia
Reduces
Parkinsonism
Advantages compared with Benzodiazepines
Non-addictive
Less Sedation
No associated memory
Impairment
No significant withdrawal syndrome
Minimal
Overdose
potential
No
Anticholinergic Toxicity
Well tolerated by elderly patients
Disadvantages compared with Benzodiazepine
Slow onset of action (takes 2-4 weeks until effect)
Not useful in
Panic Attack
s
No
Sedative
effect
Requires repeat dosing 2-3 times per day
Precautions
Avoid use in pregnancy and
Lactation
Avoid in hepatic or renal
Impairment
Adverse Effects
Dizziness
or light headedness
Onset within 30 minutes of ingestion
Duration less than 20 minutes
Mild
Headache
Nausea
Nervousness
Insomnia
Drug Interactions
MAO Inhibitor
s
Haloperidol
(
Haldol
)
Cyclosporine
(
Sandimmune
)
Disulfiram
(
Antabuse
)
Erythromycin
and
Itraconazole
suppresses p450
Results in Buspirone levels 5-13 times normal
Protocol to convert from Benzodiazepine to Buspirone
Convert short-acting
Benzodiazepine
to long-acting
Example:
Alprazolam
to
Clonazepam
Start Buspirone at above doses
Taper long-acting
Benzodiazepine
over 60 to 90 days
References
(1997) Clin Pharmacol Ther, 32:348 [PubMed]
Cadieux (1996) Am Fam Physician 53(7): 2349-53 [PubMed]
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