Buspirone vs. Xanax

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Buspirone vs. Xanax

  • Buspirone and Xanax (alprazolam) are medications used to treat anxiety.
  • Xanax is in the benzodiazepine class of drugs, while buspirone is not chemically related to benzodiazepines and works differently than other anxiolytics.
  • The brand name of buspirone called BuSpar is discontinued in the U.S. Buspirone is available as a generic drug.
  • Side effects of buspirone and Xanax are different.
  • Side effects of buspirone include dizziness, nausea, headache, nervousness, lightheadedness, excitement, and insomnia.
  • Side effects of Xanax include drowsiness, fatigue, memory problems, speech problems, constipation, and changes in weight.
  • Both buspirone and Xanax may interact with itraconazole, nefazodone, and rifampin.
  • Buspirone may also interact with monoamine oxidase (MAO) inhibitors, trazodone, warfarin, grapefruit juice, and erythromycin.
  • Xanax may also interact with ketoconazole, cimetidine, fluvoxamine, alcohol and medications that can make you sleepy (such as barbiturates and narcotics), and carbamazepine.
  • Suddenly stopping Xanax after prolonged use can lead to symptoms of withdrawal such as insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, and fatigue.

What are buspirone and Xanax?

Buspirone is used for the treatment of anxiety. Its mechanism of action is not clearly understood but may involve effects on the neurotransmitters serotonin and dopamine. Buspirone may work by stimulating serotonin type 1A receptors on nerves, thereby altering the chemical messages that nerves receive. Unlike medications for anxiety of the benzodiazepine class, buspirone does not cause sedation.

Xanax (alprazolam) is an anti-anxiety medication in the benzodiazepine family, the same family that includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), and flurazepam (Dalmane). Xanax and other benzodiazepines act by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. GABA inhibits activity in the brain. It is believed that excessive activity in the brain may cause anxiety or other psychiatric disorders.

What are the side effects of buspirone and Xanax?

Buspirone

The most common side effects associated with buspirone are:

  • dizziness,
  • nausea,
  • headache, nervousness,
  • lightheadedness,
  • excitement, and
  • insomnia.

Other important but less frequent side effects include

  • unsteady gait,
  • diarrhea,
  • excitement,
  • weakness,
  • hostility,
  • skin rash, and
  • tremors.

Xanax

The most common side effects of Xanax taken at lower doses are:

  • Drowsiness
  • Fatigue

Other side effects include:

  • Memory problems
  • Speech problems
  • Constipation
  • Changes in weight
  • Addiction (dependency)

Addiction is more likely to occur at high doses given over prolonged periods of time. Abrupt discontinuation of alprazolam after prolonged use can lead to symptoms of withdrawal such as:

  • Insomnia
  • Headaches
  • Nausea
  • Vomiting
  • Lightheadedness
  • Sweating
  • Anxiety
  • Fatigue

Seizures can occur in more severe cases of withdrawal. Consequently, patients on alprazolam for extended periods of time should slowly taper the medication under a doctor's supervision rather than abruptly stopping the medication.

What is the dosage for buspirone vs. Xanax?

Buspirone

  • The usual starting adult dose is 10-15 mg daily given in 2 or 3 doses. The dose may be increased by 5 mg every 2 to 4 days until an effective dose is found.
  • The maximum adult dose is 60 mg daily, but most patients respond to 15-30 mg daily.
  • Although food increases the amount of buspirone that is absorbed, the importance of this effect is not clear. Buspirone can be taken with or without food but preferably on a consistent basis.

Xanax

  • The starting dose for treating anxiety is 0.25-0.5 mg 3 to 4 times daily using immediate release tablets. The dose may be increased every 3-4 days to a maximum dose of 4 mg daily.
  • The starting dose for treating panic attacks is 0.5 mg 3 times daily. Doses can be increased every 3-4 days but by no more than 1 mg daily.
  • The effective dose for preventing panic attacks may be as high as 10 mg daily for some patients. The starting dose when using extended release tablets to treat panic disorder is 0.5 mg once daily and the average dose is 3-6 mg once daily.
  • Alprazolam may be taken with or without food.

What drugs interact with buspirone and Xanax?

Buspirone

Buspirone may interact with drugs called monoamine oxidase (MAO) inhibitors, such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane) which are used in psychiatric disorders. The use of buspirone with these drugs can cause increased blood pressure. A similar reaction may occur if buspirone is combined with linezolid (Zyvox), an antibiotic that is also an MAO inhibitor. The combination of buspirone and trazodone (Desyrel), an antidepressant, may cause abnormal liver enzymes in the blood.

The combination of buspirone and warfarin (Coumadin), a blood thinner, may accentuate the effects of warfarin and increase the risk of bleeding. Patients taking buspirone should not drink grapefruit juice, since the juice (even well after a dose of buspirone is taken) can increase the amount of buspirone in the blood, possibly leading to side effects.

Inactivation and removal of buspirone is mediated by liver enzymes. Drugs (for example, erythromycin, itraconazole [Sporanox], nefazodone [Serzone]) that inhibit these liver enzyme increase blood concentrations of buspirone, and drugs (for example, rifampin) that enhance these enzymes decrease blood concentrations of buspirone. Increased blood concentrations may increase side effects while decreased blood concentrations may reduce efficacy.

Xanax

Ketoconazole (Nizoral), itraconazole (Sporanox), nefazodone (Serzone), cimetidine (Tagamet), and fluvoxamine (Luvox) increase concentrations in the blood of alprazolam and therefore may increase the side effects of alprazolam.

Alprazolam interacts with alcohol and medications (for example, barbiturates, and narcotics) that suppress activity in the brain by suppressing activity more and causing sedation.

Carbamazepine and rifampin reduce the effect of alprazolam by increasing metabolism and elimination of alprazolam in the liver.

Are buspirone and Xanax safe to take while pregnant and breastfeeding?

Buspirone

  • There are no adequate studies of buspirone in pregnant women.
  • It is not known if buspirone is secreted in human breast milk. Because buspirone is secreted in the breast milk of animals, however, it should not be used by women who are nursing infants.

Xanax

  • Benzodiazepines, such as alprazolam, can cause fetal abnormalities and should not be used in pregnancy.
  • Alprazolam is excreted in breast milk and can affect nursing infants. Therefore, it should not be used by women who are nursing.

Summary

Buspirone and Xanax (alprazolam) are both used to treat anxiety and depression. Xanax is a sedative in the benzodiazepine family, while buspirone is chemically different. Xanax is habit forming and sudden stoppage can cause withdrawal symptoms.

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Medically Reviewed on 10/27/2017
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