How is BuSpar Used in the Treatment of Social Anxiety Disorder?

BuSpar (buspirone hydrochloride [HCL]) is a medication used to treat anxiety disorders and for short-term relief from anxiety. BuSpar is not related chemically or pharmacologically to other anti-anxiety medications such as benzodiazepines or other sedatives. The effectiveness of BuSpar for treating generalized anxiety disorder (GAD) has been established.

Bristol-Meyers Squibb obtained approval from the Food and Drug Administration (FDA) in 1986 for use of buspirone (trade name BuSpar) to be used in the treatment of GAD. However, the patent expired in 2001 and buspirone is now sold as a generic drug.

Buspirone is from the azaspirone class of medications, which includes other anxiolytic (anti-anxiety) and antipsychotic medications. BuSpar has effects on neurotransmitters in the brain such as serotonin and dopamine. Specifically, it is a serotonin receptor agonist, which means that it increases action at serotonin receptors in your brain, which in turn helps to alleviate anxiety.

Buspirone is commonly used as an add-on to other medications such as selective serotonin reuptake inhibitors (SSRIs) for treatment of depression or anxiety, rather than a first-line treatment. BuSpar may also be prescribed if other medications have been ineffective or involved too many side effects. It is most often prescribed for generalized anxiety disorder.

BuSpar tablets should be taken consistently either with food or without. It is usually taken two or three times daily. The recommended starting dose of BuSpar is 5 mg twice daily. The dose may be increased by 5 mg every 2 to 3 days, with a maximum dose that generally does not exceed 60 mg. Most patients respond to a dose in the range of 15 to 30 mg. BuSpar is slow acting, so it may take a few weeks to feel the effects.

Your doctor will evaluate your situation and how you respond to the medication to determine the optimal length of time that you should take BuSpar. Typically, the medication is taken for several months up to a year. When your doctor decides that you should stop taking BuSpar, the dose will gradually be reduced, to help avoid potential effects of withdrawal.

Buspar (buspirone hydrochloride) should not be taken by those with a hypersensitivity to the drug. Drug hypersensitivity refers to immune-medicated reactions to drugs, with symptoms ranging from mild to severe. In cases of hypersensitivity, your doctor will discontinue the medication treatment. 

Buspar should also be used with caution in persons with compromised liver function or pre-existing medical conditions such as diabetes. Because removal of buspirone is mediated by liver enzymes, there may be increased blood concentrations of buspirone if the liver is not functioning normally. In addition, as buspirone can affect blood glucose levels, this is problematic for persons with diabetes.

Buspar is not recommended for nursing mothers as there is evidence to suggest it may be secreted into breast milk. Its safety during pregnancy has also not been adequately studied.

BuSpar can potentially interact with numerous medications. The use of buspirone with monoamine oxidase inhibitors (MAOIs) can result in increased blood pressure. Combining buspirone with the blood thinner warfarin (Coumadin) can increase the risk of bleeding. In addition, medications that have action on liver enzymes, such as erythromycin, may increase or decrease concentrations of buspirone in the blood, which can lead to more side effects, or a lack of effectiveness of the drug. For these reasons, it is important that your doctor is aware of all medications that you are taking before being prescribed BuSpar.

In addition, it is best to avoid using alcohol while taking BuSpar. Mixing alcohol with BuSpar can lead to increased drowsiness and feeling lightheaded. More severe implications of this combination include problems with muscle control, memory, and breathing.

A range of adverse effects is possible when taking Buspar, including dizziness, nausea, headache, nervousness or excitement, and lightheadedness.

Other more rare but potential adverse effects include the following:

• drowsiness, fatigue
• vomiting, upset stomach, stomach pain
• constipation, diarrhea
• dry mouth
• difficulty sleeping
• weakness, numbness

The more common side effects are seen in about 10% of cases, while the rarer side effects are seen only in around 2% of people taking the medication. Side effects are more common when the medication is first taken, and may lessen after a few weeks.

Although BuSpar is less sedating than many other anxiety medications, use caution if driving, operating machinery or participating in hazardous activities. There is little risk of physical or psychological dependence on BuSpar, and the risk of overdose is low.

One small study from 1993 showed improvement after use of buspirone in a 12-week open trial with 17 patients with generalized social phobia based on DSM-III-R criteria (12 patients showed improvement). However, a double-blind placebo-controlled study of 30 patients with SAD in 1997 showed no improvement compared to placebo.

These results suggest that buspirone as a single treatment option may not be helpful for social anxiety disorder that does not accompany other diagnoses. However, if you do not respond to other medications such as selective serotonin reuptake inhibitors (SSRIs), buspirone may be an option to augment your current treatment plan. 

If BuSpar does not alleviate your anxiety or you are not able to take it due to a medical condition or medication inferaction, your doctor can determine the best alternative medication or form of treatment for your situation. These might include benzodiazepines, SSRIs, or therapy such as cognitive-behavioral therapy (CBT).

If you have been prescribed BuSpar for anxiety, be sure to follow your doctor's instructions and report any ill effects. If you find the medication is not making a difference in your symptoms after a few weeks, it might be worthwhile asking your doctor whether another medication would be a better choice.