Buspirone Vs. Xanax: Drug Comparison

Buspirone is the active ingredient in the brand-name medication BuSpar^®. The information below is about brand name BuSpar. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

BuSpar (buspirone) is an anxiolytic medication used to treat generalized anxiety disorder (GAD) by affecting neurotransmitters in the brain, particularly serotonin and dopamine. Unlike benzodiazepines, it does not cause sedation or have a significant risk of dependence. Its FDA-approved indication is for the management of anxiety disorders, and it is sometimes used off-label for conditions like depression or anxiety-related symptoms in other psychiatric disorders. BuSpar is available in tablet form, typically taken two or three times daily. Common side effects include dizziness, headaches, and nausea, and it can interact with MAO inhibitors and other serotonergic drugs.

Xanax^® (alprazolam) is a benzodiazepine medication used to treat anxiety and panic disorders by enhancing the activity of GABA, a neurotransmitter that calms the nervous system. Its FDA-approved indications include the treatment of generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. Xanax is available in tablet, extended-release tablet, and oral solution forms, typically taken once to multiple times daily depending on the dose. Common side effects include impaired coordination, low blood pressure, difficulty speaking, and increased libido. Serious risks include dependence, withdrawal, and respiratory depression, especially when combined with opioids or alcohol. Xanax carries a boxed warning for the risk of abuse, dependence, and potentially fatal respiratory depression when used with other central nervous system (CNS) depressants.

Antianxiety agent

Benzodiazepine

BuSpar (buspirone) is indicated:

• For the management of anxiety disorders or the short-term relief of the symptoms of anxiety

Xanax (alprazolam) is indicated for the:

• Acute treatment of generalized anxiety disorder in adults

• Treatment of panic disorder with or without agoraphobia in adults

• Typically taken orally twice or three times daily

• Comes in 5 mg, 7.5 mg, 10 mg, 15 mg, and 30 mg tablets

• Typically taken orally three times daily

• Comes in 0.25 mg, 0.5 mg, 1 mg, and 2 mg tablets

The more commonly observed untoward events associated with the use of BuSpar not seen at an equivalent incidence among placebo-treated patients include:

• Dizziness

• Nausea

• Headache

• Nervousness

• Lightheadedness

• Excitement

The most common adverse reactions reported in clinical trials for generalized anxiety disorder and panic disorder (incidence >5% and at least twice that of placebo) include:

• Impaired coordination

• Low blood pressure

• Difficulty forming or pronouncing words

• Increased libido

• Hypersensitive to buspirone hydrochloride

• Drug interactions: MAO inhibitors, amitriptyline, diazepam, haloperidol, nefazodone, trazodone, triazolam/flurazepam, other psychotropics, inhibitors and inducers of cytochrome P450 3A4, diltiazem and verapamil, erythromycin, grapefruit juice, itraconazole, rifampin, and others

• Known hypersensitivity to alprazolam or other benzodiazepines

• Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors, except ritonavir

• Drug interactions: Opioids, other central nervous system (CNS) depressants, digoxin, CYP3A inhibitors (except ritonavir), CYP3A inducers

• The administration of buspirone to a patient taking a monoamine oxidase inhibitor (MAOI) may pose a hazard

• Because buspirone has no established antipsychotic activity, it should not be employed in lieu of appropriate antipsychotic treatment

• Interference with cognitive and motor performance

• Potential for withdrawal reactions in sedative/hypnotic/anxiolytic drug-dependent patients

• Possible concerns related to buspirone's binding to dopamine receptors

• Pregnancy: This drug should be used during pregnancy only if clearly needed

• Breastfeeding: Administration to nursing women should be avoided if clinically possible

• Effects on driving and operating machinery

• Patients with depression: Exercise caution in patients with signs or symptoms of depression

• Neonatal sedation and withdrawal syndrome

• Breastfeeding: Breastfeeding not recommended

WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS; ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.

The use of benzodiazepines, including Xanax, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Before prescribing Xanax and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

• Abrupt discontinuation or rapid dosage reduction of Xanax after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue Xanax or reduce the dosage.

*This information is from the label for brand name BuSpar^®. See the Full Prescribing Information for more complete information. Buspirone, the active ingredient in BuSpar, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient buspirone.

*This information is from the label for brand name Xanax^®. See the Full Prescribing Information for more complete information. Alprazolam, the active ingredient in Xanax, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient alprazolam.