Buspar

Action

Unclear. Thought to bind to serotonin and dopamine receptors in CNS, increasing dopamine metabolism and impulse formation. Also thought to inhibit neuronal firing and reduce serotonin turnover.

Availability

Tablets: 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg

Indications and dosages

➣ Anxiety disorders; anxiety symptoms

Adults: 7.5 mg P.O. b.i.d.; increase by 5 mg/day q 2 to 3 days as needed (not to exceed 60 mg/day). Common dosage is 20 to 30 mg/day in divided doses.

Off-label uses

• Parkinsonian syndrome

• Symptomatic relief of depression

Contraindications

• Hypersensitivity to drug

• Severe renal or hepatic impairment

• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:

• patients receiving concurrent anxi-olytics or psychotropics

• pregnant or breastfeeding patients

• children.

Administration

• Give with food to minimize GI upset.

• Know that full benefit of drug therapy may take up to 2 weeks.

Adverse reactions

CNS: dizziness, drowsiness, nervousness, headache, insomnia, weakness, personality changes, numbness, paresthesia, tremor, dream disturbances

CV: chest pain, palpitations, tachycardia, hypertension, hypotension

EENT: blurred vision, conjunctivitis, tinnitus, nasal congestion, sore throat

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dry mouth

GU: dysuria, urinary frequency or hesitancy, menstrual irregularities, menstrual spotting, libido changes

Musculoskeletal: myalgia

Respiratory: chest congestion, hyperventilation, dyspnea

Skin: rash, alopecia, blisters, pruritus, dry skin, easy bruising, edema, flushing, clammy skin, excessive sweating

Other: altered taste or smell, fever

Interactions

Drug-drug. Erythromycin, itraconazole: increased buspirone blood level

MAO inhibitors: hypertension Trazodone: increased risk of adverse hepatic effects

Drug-food. Grapefruit juice: increased buspirone blood level and effects

Drug-herbs. Hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor mental status closely.

• Assess hepatic and renal function regularly to detect drug toxicity.

Patient teaching

• Instruct patient to take drug with food.

• Advise patient not to use drug to manage everyday stress or tension.

• Instruct patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Caution patient to avoid alcohol because it increases CNS depression.

• Emphasize importance of keeping follow-up appointments to check progress.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.