|Systematic (IUPAC) name|
|Metabolism||Hepatic mostly via CYP3A4|
|Biological half-life||2-3 hours|
|Excretion||Urine (29-63%), Faeces (18-38%)|
|ATC code||N05BE01 (WHO)|
|Molar mass||385.50314 g/mol|
Buspirone (// BEW-spi-rohn), trade name Buspar, is an anxiolytic psychotropic drug of the azapirone chemical class. It is primarily used to treat generalized anxiety disorder (GAD). Unlike most drugs predominantly used to treat anxiety, buspirone's pharmacology is not related to benzodiazepines or barbiturates, and so does not carry the risk of physical dependence and withdrawal symptoms for which those drug classes are known.
In 1986, Bristol-Myers Squibb gained Food and Drug Administration (FDA) approval for buspirone in the treatment of GAD. The patent placed on buspirone expired in 2001 and buspirone is now available as a generic drug.
Buspirone is approved in the United States by the FDA for the treatment of anxiety disorders and the short-term relief of the symptoms of anxiety. Likewise in Australia, buspirone is licensed for the treatment of anxiety disorders. In the United Kingdom, buspirone is indicated only for the short-term treatment of anxiety.
Although not approved for this indication, studies such as STAR*D have shown buspirone to be an effective augmentation agent alongside treatment with selective serotonin reuptake inhibitors (SSRIs) for clinical depression and is also used to counter the sexual side effects (anorgasmy and impotence) of the SSRI.
Several clinical trials, most randomised double-blind trials (and in one buspirone was used as an adjunct to atomoxetine) and one open-label, have been conducted to evaluate the utility of buspirone in the treatment of attention deficit hyperactivity disorder with mostly positive results.
For generalized anxiety disorder (GAD): 15–60 mg. Starting dose is 5 mg, 3 times daily, average dosage being 20–30 mg a day. If symptoms still persist after several weeks then the dose may be titrated up to 60 mg. Due to Buspar's short half-life and linear pharmacokinetics, dosage can be increased by 5 mg every two to three days.
Very common (>10% incidence)
- Somnolence (sleepiness)
- Premature ejaculation[not in citation given]
Common (1-10% incidence)
- Sleep disorder
- Disturbance in attention
- Confusional state
- Tachycardia (fast heart rate)
- Chest pain
- Sinusitis (nasal congestion)
- Pharyngolaryngeal pain
- Paraesthesia (tingling skin)
- Blurred vision
- Abnormal coordination
- Cold sweat
- Abdominal pain
- Dry mouth
- Musculoskeletal pain
- Redness and itching of the eyes
- Altered taste
- Increased appetite
- Rectal bleeding
- Urinary frequency
- Urinary hesitancy
- Menstrual irregularity or spotting
- Muscle cramps
- Muscle spasms
- Muscle rigidity/stiffness
- Involuntary movements
- Shortness of breath
- Chest congestion
- Changes in libido
- Easy bruising
- Dry skin
- Facial oedema
- Mild increases in hepatic aminotransferases (AST, ALT)
- Weight gain
- Roaring sensation in the head
- Weight loss
- Noise intolerance
- Loss of interest
- Dissociative reaction
Rare (<0.1% incidence)
- Cerebrovascular accident (stroke)
- Myocardial infarction (heart attack)
- Congestive heart failure
- Feelings of claustrophobia
- Cold intolerance
- Slurred speech
- Extrapyramidal symptoms including dyskinesias (acute & delayed)
- Dystonic reactions
- Cogwheel rigidity
- Emotional lability
- Suicidal ideation
- Transient difficulty with recall
- Serotonin syndrome
- Restless leg syndrome
- Eye pain
- Altered sense of smell
- Pressure on eyes
- Inner ear abnormality
- Tunnel vision
- Irritable colon
- Burning of the tongue
- Amenorrhoea (cessation of menstrual cycles)
- Pelvic inflammatory disease
- Urinary retention
- Delayed ejaculation
- Hair loss
- Thinning of nails
- Allergic reactions including urticaria, ecchymosis, angioedema
- Alcohol abuse
- Bleeding disturbance
- Loss of voice
- Thyroid abnormality
- Hypersensitivity to buspirone
- Metabolic acidosis, as in diabetes
- Should not be used with MAO inhibitors
- Severely compromised liver and/or renal function
Buspirone has been shown in vitro to be metabolized by CYP3A4. This finding is consistent with the in vivo interactions observed between buspirone and these inhibitors or inducers of cytochrome P450 3A4 (CYP3A4), among others:
- Itraconazole: Increased plasma level of buspirone
- Rifampicin: Decreased plasma levels of buspirone
- Nefazodone: Increased plasma levels of buspirone
- Haloperidol: Increased plasma levels of haloperidol
- Carbamazepine: Decreased plasma levels of buspirone
- Commercial grapefruit juice: contains rind, the source of the competing compound: Significantly increases the plasma levels of buspirone
The likely mechanism of the interaction caused by grapefruit juice is delayed gastric emptying or inhibition by a substance in grapefruit rind of cytochrome P450 3A4-mediated first-pass metabolism of buspirone.
Activated charcoal is believed to be an effective treatment for overdose, provided the patient is treated promptly. Expected symptoms (based on symptoms in male healthy volunteers treated with 375 mg/day — compared to the maximum daily licensed dosage in Australia, the UK, and the US):
- Gastric distress
Buspirone appears to be relatively benign in cases of single-drug overdose, although no definitive data on this subject appear to be available.
Pharmacology and mechanism
Buspirone functions as a serotonin 5-HT1A receptor partial agonist (IA = 0.465). It is this action that is thought to mediate its anxiolytic and antidepressant effects. Additionally, it functions as a presynaptic dopamine antagonist at the D2, D3 and D4 receptors. Buspirone is also a partial α1 receptor agonist. Buspirone also appears to produce some oxytocin stimulation via 5-HT1A receptor-induced action. Buspirone binds to 5-HT type 1A serotonin receptors on presynaptic neurons in the dorsal raphe and on postsynaptic neurons in the hippocampus, thus reducing the firing rate of 5-HT-containing neurons in the dorsal raphe. Buspirone also binds at dopamine type 2 (DA2) receptors, blocking presynaptic dopamine receptors. Buspirone increases firing in the locus ceruleus, an area of brain where norepinephrine cell bodies are found in high concentration. The net result of buspirone actions is that serotonergic activity is suppressed while noradrenergic and dopaminergic cell firing is enhanced. [not in citation given]
Binding Profile of Buspirone (towards cloned human receptors)
|Receptor||Binding Affinity (Ki [nM])||Action|
Comparison to benzodiazepines
Abrupt discontinuation of diazepam after six weeks of continuous administration resulted in withdrawal symptoms. This was not the case when administration of buspirone was ceased after six weeks. It may take several weeks before buspirone's anxiolytic effects become noticeable, and many patients may also need a higher dosage to adequately respond to treatment.
Buspirone's chemical structure and mechanism of action are completely unrelated to those of benzodiazepines and is not effective as a treatment for benzodiazepine withdrawal. Unlike benzodiazepines, buspirone is not a drug of abuse.
Alkylation of 1-(2-pyrimidyl)piperazine (1) with 3-chloro-1-cyanopropane (2, 4-chlorobutyronitrile) gives 3, which is reduced either by hydrogenation over Raney nickel catalyst, or with LAH. The resulting 1° amine (4) from the previous step is then reacted with 3,3-Tetramethyleneglutaric anhydride (5, 8-Oxaspiro[4.5]decane-7,9-dione) in order to yield buspirone (6).
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