Anti-anxiety: buspirone, Buspar

Generic Name: buspirone
Brand Name(s): Buspar
Common Use: Antianxiety agent

Buspirone is a psychotropic drug with anxiolytic properties which belongs chemically to the class of compounds known as the azaspirodecanediones. Buspirone shares some of the properties of the benzodiazepines and the neuroleptics, as well as demonstrating other pharmacological action. Buspirone affects a variety of dopamine mediated biochemical and behavioral events, but is free of cataleptic activity.

Short-term symptomatic relief of excessive anxiety in patients with generalized anxiety disorder (psychoneurotic disorder).

Contraindications

In patients hypersensitive to buspirone HCl. Buspirone is contraindicated in patients with severe hepatic or severe renal impairment.

The occurrence of elevated blood pressure in patients receiving both buspirone and a MAO inhibitor has been reported. Therefore, it is recommended that buspirone should not be used concomitantly with a MAO inhibitor.

Patients who have previously taken benzodiazepines may be less likely to respond to buspirone than those who have not. A drug-free interval is desirable between withdrawal of the benzodiazepine and initiation of buspirone, in order to increase the likelihood of distinguishing between benzodiazepine withdrawal effects and unrelieved anxiety due to possible failure of buspirone in this category of patients.

Occupational Hazards:

Until further experience is obtained with buspirone, patients should be warned not to operate an automobile or undertake activities requiring mental alertness, judgment and physical coordination, until they are reasonably certain that buspirone does not affect them adversely.

Adverse Effects

The most common adverse reactions encountered with buspirone are dizziness, headache, drowsiness and nausea.

Adverse reactions reported include the following:
Dizziness, headache, drowsiness, lightheadedness, insomnia, fatigue, nervousness, decreased concentration, excitement, depression, confusion, nightmares/vivid dreams, anger/hostility. Infrequently (<1%) depersonalization, noise intolerance, euphoria/feeling high, dissociative reaction, fear, loss of interest, dysphoria, hallucinations, seizures, suicidal thoughts. Rarely, slurred speech, claustrophobia, cold intolerance, stupor, psychosis. Paresthesia, weakness, incoordination, tremor, numbness. Infrequently, muscle cramps and spasms, rigid/stiff muscles, involuntary movements, akathisia, slowed reaction time. Rarely, tingling of limbs, stiff neck, rigidity of jaw, ataxia. Dry mouth, sweating/clamminess, blurred vision, constipation. Infrequently, urinary frequency, retention and burning, flushing. Tachycardia, chest pain, palpitations. Infrequently, syncope, hypotension, hypertension. Rarely, congestive heart failure, cerebrovascular accident, myocardial infarction, cardiomyopathy, bradycardia, EKG change. Nausea, gastrointestinal distress, diarrhea, vomiting. Infrequently, flatulence, increased appetite, anorexia, hypersalivation, rectal bleeding, irritable colon. Rarely, burning tongue. Nasal congestion. Infrequently, shortness of breath, chest congestion, difficulty breathing, hyperventilation. Rarely, epistaxis. Infrequently, decreased and increased libido, weight gain, weight loss, menstrual irregularity/breakthrough bleeding. Rarely, delayed ejaculation, impotence, galactorrhea, amenorrhea, thyroid abnormality. Skin rash, sore throat. Infrequently, edema/facial edema, pruritus, chills/fever. Rarely, photophobia, erythema, flu-like symptoms. Infrequently, increases in liver enzymes. Rarely, eosinophilia, leukopenia, thrombocytopenia. Tinnitus, muscle aches/pains. Infrequently, redness/itching of eyes, altered taste/smell, roaring sensation in head, malaise, easy bruising, dry skin, arthralgia, blisters, hair loss. Rarely, acne, thinning of nails, sore eyes, inner ear abnormality, pressure on eyes, nocturia, enuresis, hiccups, voice loss, alcohol abuse.

Additional reports have included rare occurrences of allergic reaction, cogwheel rigidity, dystonic reaction, ecchymosis, emotional lability and tunnel vision. Because of the uncontrolled nature of these spontaneous reports, a causal relationship to buspirone treatment has not been determined.

Overdose

There is no specific antidote for buspirone. Management should, therefore, be symptomatic and supportive. Any patient suspected of having taken an overdose should be admitted to a hospital as soon as possible, and the stomach emptied by gastric lavage.

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