Drug reference
Anxiety (short-term use) ▶BY MOUTH ▶Adult: 5 mg 2–3 times a day, increased if necessary up to 45 mg daily, dose to be increased at intervals of 2–3 days; usual dose 15–30 mg daily in divided doses
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DUE TO INTERACTIONS ▶Manufacturer advises reduce dose to 2.5 mg twice daily with concurrent use of potent inhibitors of CYP3A4.
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Epilepsy Acute pulmonary insufficiency. marked neuromuscular respiratory weakness. not for use alone to treat chronic psychosis (in adults). not for use alone to treat depression (or anxiety associated with depression) (in adults). obsessional states. phobic states. sleep apnoea syndrome. unstable myasthenia gravis
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Does not alleviate symptoms of benzodiazepine withdrawal CAUTIONS, FURTHER INFORMATION A patient taking a benzodiazepine still needs to have the benzodiazepine withdrawn gradually; it is advisable to do this before starting buspirone. Avoid prolonged use (and abrupt withdrawal thereafter). debilitated patients (reduce dose)(in adults). elderly (reduce dose). history of alcohol dependence or abuse. history of drug dependence or abuse. myasthenia gravis. personality disorder (within the fearful group— dependent, avoidant, obsessive-compulsive) may increase risk of dependence. respiratory disease CAUTIONS, FURTHER INFORMATION ▶Paradoxical effects A paradoxical increase in hostility and aggression may be reported by patients taking benzodiazepines. The effects range from talkativeness and excitement to aggressive and antisocial acts. Adjustment of the dose (up or down) sometimes attenuates the impulses. Increased anxiety and perceptual disorders are other paradoxical effects. ▶Elderly Prescription potentially inappropriate (STOPP criteria): . for a duration of 4 weeks or longer (no indication for longer treatment; risk of adverse events; all benzodiazepines should be withdrawn gradually if taken for more than 2 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped Nervous system abruptly) . with acute or chronic respiratory failure i.e. PaO2< 8 kPa with or without PaCO2> 6.5 kPa (risk of exacerbation of respiratory failure) . in patients prone to falls (sedative, may cause reduced sensorium and impair balance) See also Prescribing in the elderly p. 33.
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→Appendix 1: buspirone
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▶Common or very common Abdominal pain. anger. anxiety. chest pain. cold sweat. concentration impaired. confusion . constipation. depression. diarrhoea. dizziness. drowsiness. dry mouth. fatigue. headache. laryngeal pain . movement disorders. musculoskeletal pain. nasal congestion. nausea. paraesthesia. skin reactions. sleep disorders. tachycardia. tinnitus. tremor. vision disorders. vomiting ▶Rare or very rare Depersonalisation. emotional lability. galactorrhoea. hallucination. memory loss. parkinsonism . psychotic disorder. seizure. serotonin syndrome. syncope. urinary retention ▶Common or very common Alertness decreased. anxiety. ataxia (more common in elderly). confusion (more common in elderly). depression. dizziness. drowsiness. dysarthria. fatigue. gastrointestinal disorder. headache. hypotension. mood altered. muscle weakness. nausea. respiratory depression (particularly with high dose and intravenous use—facilities for its treatment are essential). sleep disorders. suicidal ideation. tremor. vertigo. vision disorders. withdrawal syndrome ▶Uncommon Agitation (more common in children and elderly). anterograde amnesia. behaviour abnormal. hallucination. libido disorder. rash. urinary disorders ▶Rare or very rare Aggression (more common in children and elderly). blood disorder. delusions. jaundice. paradoxical drug reaction. psychosis. restlessness (with sedative and peri-operative use) ▶Frequency not known Drug dependence Overdose Benzodiazepines taken alone cause drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma. For details on the management of poisoning, see Benzodiazepines, under Emergency treatment of poisoning p. 1430.
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Avoid. Risk of neonatal withdrawal symptoms when used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression.
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Avoid.
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Manufacturer advises caution; avoid in severe hepatic failure. Dose adjustments Manufacturer advises titrate individual dose carefully in cirrhosis—consult product literature. In general, manufacturers advise caution in mild to moderate impairment; avoid in severe impairment. Benzodiazepines with a shorter half-life are considered safer. Dose adjustments In general, manufacturers advise dose reduction in mild to moderate impairment, adjust dose according to response.
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Avoid if eGFR less than 20 mL/minute/1.73 m2. Dose adjustments Reduce dose. Increased cerebral sensitivity to benzodiazepines.
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MHRA/CHM ADVICE: BENZODIAZEPINES AND OPIOIDS: REMINDER OF RISK OF POTENTIALLY FATAL RESPIRATORY DEPRESSION (MARCH 2020) The MHRA reminds healthcare professionals that benzodiazepines and benzodiazepine-like drugs co- prescribed with opioids can produce additive CNS depressant effects, thereby increasing the risk of sedation, respiratory depression, coma, and death. Healthcare professionals are advised to only co-prescribe if there is no alternative and, if necessary, the lowest possible doses should be given for the shortest duration. Patients should be closely monitored for signs of respiratory depression at initiation of treatment and when there is any change in prescribing, such as dose adjustments or new interactions. If methadone is co- prescribed with a benzodiazepine or benzodiazepine-like drug, the respiratory depressant effect of methadone may be delayed; patients should be monitored for at least 2 weeks after initiation or changes in prescribing. Patients should be informed of the signs and symptoms of respiratory depression and sedation, and advised to seek urgent medical attention should these occur.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet ▶Buspirone hydrochloride (Non-proprietary) Buspirone hydrochloride 5 mg Buspirone 5mg tablets | 30 tablet P £21.00 DT = £4.16 Buspirone hydrochloride 7.5 mg Buspirone 7.5mg tablets | 30 tablet P £25.99 DT = £25.99 Buspirone hydrochloride 10 mg Buspirone 10mg tablets | 30 tablet P £29.00 DT = £4.66 HYPNOTICS, SEDATIVES AND ANXIOLYTICS › BENZODIAZEPINES Benzodiazepines f
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Driving and skilled tasks May affect performance of skilled tasks (e.g. driving); effects of alcohol may be enhanced. Driving and skilled tasks May cause drowsiness, impair judgement and increase reaction time, and so affect ability to drive or perform skilled tasks; effects of alcohol increased. Moreover the hangover effects of a night dose may impair performance on the following day. For information on 2015 legislation regarding driving whilst taking certain controlled drugs, including benzodiazepines, see Drugs and driving under Guidance on prescribing p. 1. eiiii F 359
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5 mg 2–3 times a day, increased if necessary up
First-line fragment. Read the complete Indications and Dose section above.
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