Buspirone hydrochloride

buspirone hydrochloride

(byoo spye' rone)

BuSpar

Pregnancy Category B

Drug class

Anxiolytic

Therapeutic actions

Mechanism of action not known; lacks antiseizure, sedative, or muscle relaxant properties; binds serotonin receptors, but the clinical significance is unclear.

Indications

·        Management of anxiety disorders or short-term relief of symptoms of anxiety

·        Unlabeled use: Decreasing the symptoms (aches, pains, fatigue, cramps, irritability) of PMS

Contraindications and cautions

·        Contraindicated with hypersensitivity to buspirone; marked liver or renal impairment; lactation.

·        Use cautiously with pregnancy, mild renal or hepatic impairment.

Available forms

Tablets—5, 7.5, 10, 15, 30 mg

Dosages

ADULTS

Initially, 15 mg/day PO (7.5 mg tid). Increase dosage 5 mg/day at intervals of 2–3 days to achieve optimal therapeutic response. Do not exceed 60 mg/day. Divided doses of 20–30 mg/day have been used.

PEDIATRIC PATIENTS

Safety and efficacy for children < 18 yr not established.

Pharmacokinetics

Route	Onset	Peak
Oral	7–10 days	40–90 min

Metabolism: Hepatic; T_1/2: 3–11 hr

Distribution: May enter breast milk

Excretion: Urine

Adverse effects

·        CNS: Dizziness, headache, nervousness, insomnia, light-headedness, excitement, dream disturbances, drowsiness, decreased concentration, anger, hostility, confusion, depression, tinnitus, blurred vision, numbness, paresthesia, incoordination, tremor, depersonalization, dysphoria, noise intolerance, euphoria, akathisia, fearfulness, loss of interest, disassociative reaction, hallucinations, suicidal ideation, seizures, altered taste and smell, involuntary movements, slowed reaction time

·        CV: Nonspecific chest pain, tachycardia or palpitations, syncope, hypotension, hypertension

·        GI: Nausea, dry mouth, vomiting, abdominal or gastric distress, diarrhea, constipation, flatulence, anorexia, increased appetite, salivation, irritable colon and rectal bleeding

·        GU: Urinary frequency, urinary hesitancy, dysuria, increased or decreased libido, menstrual irregularity, spotting

·        Respiratory: Hyperventilation, shortness of breath, chest congestion

·        Other: Musculoskeletal aches and pains, sweating, clamminess, sore throat, nasal congestion

Interactions

Drug-drug

·        Give with caution to patients taking alcohol, other CNS depressants

·        Decreased effects with fluoxetine

·        Increased serum levels of buspirone if taken with erythromycin, itraconazole; decrease buspirone dose to 2.5 mg and monitor closely if these combinations are used

·        Risk of increased haloperidol levels if combined

Drug-food

·        Risk of increased serum levels and toxicity if taken with grapefruit juice

Nursing considerations

Assessment

·        History: Hypersensitivity to buspirone, marked liver or renal impairment, lactation

·        Physical: Weight; T; skin color, lesions; mucous membranes, throat color, lesions, orientation, affect, reflexes, vision examination; P, BP; R, adventitious sounds; bowel sounds, normal GI output, liver evaluation; normal urinary output, voiding pattern; LFTs, renal function tests, urinalysis, CBC and differential

Interventions

·        Provide sugarless lozenges or ice chips if dry mouth or altered taste occurs.

·        Arrange for analgesic for headache or musculoskeletal aches.

Teaching points

·        Take this drug exactly as prescribed.

·        Avoid the use of alcohol, sleep-inducing, or over-the-counter drugs and grapefruit juice; these could cause dangerous effects.

·        You may experience these side effects: Drowsiness, dizziness, light-headedness (avoid driving or operating complex machinery); GI upset (eat frequent small meals); dry mouth (suck ice chips or sugarless candies); dreams, nightmares, difficulty concentrating or sleeping, confusion, excitement (reversible; will stop when the drug is discontinued).

·        Report abnormal involuntary movements of facial or neck muscles, motor restlessness; sore or cramped muscles; abnormal posture; yellowing of the skin or eyes.

Adverse effects in Italic are most common; those in Bold are life-threatening.