Chronic anxiety Non-benzodiazepines

Buspirone (Azapirone anxiolytic)

  • 7.5mg BID, ↑15mg BID after 1 week (max dose 60mg daily)
  • Onset of action in 2-4 weeks (no risk of dependence) 

Other options

  • TCAs, SSRIs, SNRIs (see below)

  • Partial agonist of serotonin receptor

  • Chronic anxiety

  • MAOI within last 14 days 🡪 risk of serotonin syndrome

  • CNS: Headache, dizziness, fatigue, depression 
  • GI: Nausea, diarrhea 
  • SE relieved with continuation of therapy

  • Substrate of CYP3A4; grapefruit juice can ↑ its concentration

  • Relative to other anxiolytics, Buspirone has low toxicity & potential for abuse
  • Since onset of action takes 2-4 weeks 🡪 cannot be used for acute stress, & on as needed basis