Klonopin (clonazepam) vs. Buspar (buspirone)

• Klonopin (clonazepam) and Buspar (buspirone) are used to provide short-term relief of symptoms in the treatment of anxiety.
• Clonazepam is primarily used to treat panic disorder, to prevent certain types of seizures, and to treat Lennox-Gastaut syndrome.
• Buspirone is especially effective in persons with limited to moderate generalized anxiety. It is not very effective in treating severe anxiety, panic disorders, or obsessive-compulsive disorders. Buspirone may also help improve symptoms of depression in patients with generalized anxiety disorder.
• Clonazepam and buspirone are different types of anxiety medications. Clonazepam is a benzodiazepine and buspirone is an anxiolytic unrelated to benzodiazepines, barbiturates, or other sedative/anxiolytic drugs.
• A brand name for clonazepam is Klonopin.
• A brand name for busprione is Buspar.
• Side effects of clonazepam and busprione that are similar include dizziness, headache, weakness, unsteadiness, sleep problems (insomnia), and skin rash.
• Side effects of clonazepam that are different from busprione include sedation, depression, loss of orientation, lack of inhibition, fatigue, amnesia, confusion, changes in sexual desire, and irritability.
• Side effects of busprione that are different from clonazepam include nausea, nervousness, lightheadedness, excitement, diarrhea, hostility, and tremors.
• Suddenly stopping clonazepam after prolonged use can lead to withdrawal symptoms.

Clonazepam is a benzodiazepine anti-anxiety medication primarily used for treating panic disorder and preventing certain types of seizures, and for short-term relief of anxiety symptoms. Other benzodiazepines include alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and flurazepam (Dalmane). Clonazepam and other benzodiazepines enhance the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. Research shows that excessive activity in the brain may lead to anxiety or other psychiatric disorders.

Buspirone is used to manage anxiety disorders and provide short-term relief of the symptoms of anxiety. It is especially effective in persons with limited to moderate generalized anxiety. It is not very effective in persons with severe anxiety, panic disorders, or obsessive-compulsive disorders. Buspirone also may help improve symptoms of depression in patients with generalized anxiety disorder. Its mechanism of action is not clearly understood, but it may work by stimulating serotonin type 1A receptors on nerves, thereby altering the chemical messages that nerves receive. It also has minor effects on dopamine receptors, but this does not contribute much to its action. Unlike benzodiazepines, buspirone does not cause sedation.

Clonazepam

The most common side effects associated with clonazepam are sedation, which is reported in approximately half of patients. Dizziness is reported in one-third of patients.

Other common side effects include:

• A feeling of depression
• Loss of orientation
• Headache
• Weakness
• Unsteadiness
• Sleep disturbance
• Lack of inhibition
• Fatigue
• Amnesia
• Confusion
• Changes in sexual desire
• Rash
• Irritability

Other serious side effects of clonazepam include:

• Respiratory depression
• Fainting
• Enlarged liver
• Withdrawal symptoms (if stopped suddenly)
• Increased heart rate
• Low blood pressure
• Blood disorders

Other serious adverse reactions:

Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need for the antiepileptic drug. Patients who begin antiepileptic therapy should be closely observed for clinical worsening, suicidal thoughts or unusual changes in behavior.

Busprione

The most common side effects associated with buspirone are:

• Dizziness
• Nausea
• Headache
• Nervousness
• Lightheadedness
• Excitement
• Insomnia

Other important but less frequent side effects include:

• Unsteady gait
• Diarrhea
• Excitement
• Weakness
• Hostility
• Skin rash
• Tremors

Clonazepam

The dose of clonazepam is tailored to the patient's needs.

• For seizures in adults, the initial dose is 1.5 mg daily in 3 divided doses.
• Dosage may be increased by 0.5 to 1 mg daily every 3 days until seizures are controlled, or side effects preclude further increases in dose.
• The maximum dose is 20 mg daily.
• The initial dose for panic disorders is 0.25 mg twice daily.
• The dose may be increased to the target dose of 1 mg daily after 3 days.

Buspirone

• The usual starting adult dose of buspirone 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.

Clonazepam

Clonazepam, like all other benzodiazepines, accentuates the effects of other drugs that slow the brain's processes -- such as alcohol, barbiturates, and narcotics -- which leads to increased sedation.

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 enzymes 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.

Clonazepam

• Clonazepam and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Clonazepam is best avoided in the first trimester and probably throughout pregnancy.
• Benzodiazepines are secreted in breast milk. Mothers who are breastfeeding should not take clonazepam.

Bursprione

• 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.