Letermovir: (Moderate) Administering letermovir with buspirone may increase buspirone concentration and risk for adverse events. In a study in healthy volunteers, co-administration of buspirone with a potent CYP3A4 inducer decreased the plasma concentrations (83.7% decrease in Cmax; 89.6% decrease in AUC) and pharmacodynamic effects of buspirone. Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: (Moderate) The combination of buspirone and other CNS depressants, such as sedating h1-blockers, can increase the risk for sedation. Amoxapine: (Moderate) CNS depressants should be combined cautiously with amoxapine because they could cause additive depressant effects and possible respiratory depression or hypotension. There is also a risk of additive CNS depression (drowsiness) when buspirone is given concomitantly with barbiturates. Azelastine: (Moderate) An enhanced CNS depressant effect may occur when azelastine is combined with other CNS depressants including buspirone. In vitro studies with encorafenib showed time-dependent inhibition of CYP3A4 and induction of CYP3A4. If buspirone is to be administered concurrently with significant CYP3A4 inhibitors, a low dose of buspirone (i.e., 2.5 mg PO twice daily) is recommended initially. Codeine; Phenylephrine; Promethazine: (Moderate) Concomitant use of CNS depressants, such as buspirone, can potentiate the effects of codeine, which may potentially lead to respiratory depression, CNS depression, sedation, or hypotensive responses. Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Concomitant use of CNS depressants, such as buspirone, can potentiate the effects of codeine, which may potentially lead to respiratory depression, CNS depression, sedation, or hypotensive responses. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Lurasidone: (Moderate) The combination of buspirone and CNS depressants like the antipsychotics can increase the risk for drowsiness, sedation, and dizziness. Find everything you need to know about Buspirone (Buspar), including what it is used for, warnings, reviews, side effects, and interactions. Cobicistat is a strong CYP3A4 inhibitor. If concurrent use of codeine and buspirone is imperative, reduce the dose of one or both drugs. Coadministration may result in elevated buspirone plasma concentrations. Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Theoretically, concurrent use of methylene blue and buspirone may increase the risk of serotonin syndrome. Description: Buspirone, an azaspirodecanedione, is an anxioselective drug w/ only little sedative effect but w/o anticonvulsant and muscle relaxant properties.It has high affinity for serotonin (5-HT 1A and 5-HT 2), moderate affinity for dopamine (D 2), and no affinity for GABA receptors. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including buspirone. Rebound or withdrawal symptoms may occur over varying time periods, depending in part on the type of drug, and its effective half-life of elimination. Thiothixene: (Moderate) The combination of buspirone and CNS depressants like thiothixene can increase the risk for sedation. It should be noted that the combination of buspirone and benzodiazepines can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. In general, buspirone suppresses serotonergic activity while enhancing noradrenergic and dopaminergic cell firing. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. In a study in healthy volunteers, co-administration of buspirone with a potent CYP3A4 inducer decreased the plasma concentrations (83.7% decrease in Cmax; 89.6% decrease in AUC) and pharmacodynamic effects of buspirone. (Moderate) The combination of buspirone and other CNS depressants, such as sedating h1-blockers, can increase the risk for sedation. (Minor) In vitro studies showed that therapeutic levels of aspirin, ASA increased the plasma concentrations of free buspirone by 23% through plasma protein binding displacement. In a study in healthy volunteers, co-administration of buspirone with a potent CYP3A4 inducer decreased the plasma concentrations (83.7% decrease in Cmax; 89.6% decrease in AUC) and pharmacodynamic effects of buspirone. Buspirone has a slow onset of action and the drug will not block the withdrawal syndrome often seen with cessation of benzodiazepine therapy in those with benzodiazepine dependence. The bioavailability of buspirone is increased when given with food as compared to the fasted state (see CLINICAL PHARMACOLOGY). If serotonin syndrome occurs, all serotonergic agents should be discontinued and appropriate medical treatment should be initiated. Phenobarbital: (Moderate) Monitor for reduced anxiolytic effect of buspirone. Encorafenib: (Moderate) Coadministration of encorafenib with buspirone may result in increased toxicity or decreased efficacy of buspirone. Buspirone increases the sensitivity of postsynaptic serotonin receptors and TCAs inhibit the reuptake of serotonin. Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. Dose adjustment of either drug should be based on clinical assessment. The recommended initial dose is 15 mg daily (7.5 mg b.i.d.). Coadministration with another strong CYP3A4 inhibitor increased the buspirone AUC by 19-fold with an increased incidence of buspirone-related adverse effects. However, as a single 150 mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction. Buspirone Forms and Dosage. If buspirone is to be administered concurrently with significant CYP3A4 inhibitors, a low dose of buspirone is recommended initially. Several cases of elevated blood pressure have been reported in patients in whom buspirone was added to a non-selective traditional MAO-inhibitor regimen. Chlordiazepoxide; Clidinium: (Moderate) It is common for patients to overlap anxiety treatment when switching from benzodiazepines to buspirone. There was no significant difference between buspirone and placebo with regard to the symptoms of GAD following doses recommended for the treatment of GAD in adults. If concurrent use of codeine and buspirone is imperative, reduce the dose of one or both drugs. Subsequent dosage adjustments should be based on clinical response. Affected cytochrome P450 isoenzymes: CYP3A4. In vivo interaction studies with these drugs have not been performed. Caution should be exercised during simultaneous use of these agents due to potential excessive CNS effects or additive hypotension. Dextromethorphan; Promethazine: (Moderate) Phenothiazines can potentiate the CNS-depressant action of other drugs such as buspirone. A pharmacokinetic study in patients with impaired hepatic function demonstrated increased plasma levels and a lengthened half-life of buspirone. If a patient has been titrated to a stable dosage on buspirone, a dose adjustment of buspirone may be necessary to maintain anxiolytic effect. Methohexital: (Moderate) Monitor for reduced anxiolytic effect of buspirone. Buspirone increases the sensitivity of postsynaptic serotonin receptors and TCAs inhibit the reuptake of serotonin. A low dose of buspirone is recommended if administered with significant CYP3A4 inhibitors. Therefore, before starting therapy with buspirone, it is advisable to withdraw patients gradually from the benzodiazepine or other prior CNS-active treatment. Because buspirone can bind to central dopamine receptors, a question has been raised about its potential to cause acute and chronic changes in dopamine-mediated neurological function (e.g., dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia). Three patients with a DSM-III-R diagnosis of posttraumatic stress disorder were successfully treated with buspirone in final maximum dosages ranging from 35-60 mg daily. These drugs used in combination may result in elevated buspirone plasma concentrations, causing an increased risk for buspirone-related adverse events. Meperidine: (Moderate) Concomitant use of CNS depressants, such as buspirone, can potentiate the effects of meperidine, which may potentially lead to respiratory depression, CNS depression, sedation, or hypotensive responses. If the two drugs are to be used in combination, a low dose of buspirone (e.g., 2.5 mg PO twice daily) is recommended. If concurrent use of codeine and buspirone is imperative, reduce the dose of one or both drugs. Log in or sign up to leave a comment Log In Sign Up. Vilazodone and buspirone should be discontinued if serotonin syndrome occurs and supportive symptomatic treatment should be initiated. If a patient has been titrated to a stable dosage on buspirone, a dose adjustment of buspirone may be necessary to maintain anxiolytic effect. Serotonin syndrome is characterized by the rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. Therefore, the administration of buspirone to patients with severe renal impairment or with renal failure cannot be recommended. In a study in healthy volunteers, co-administration of buspirone with a potent CYP3A4 inducer decreased the plasma concentrations (83.7% decrease in Cmax; 89.6% decrease in AUC) and pharmacodynamic effects of buspirone. It is recommended that the injectable buprenorphine dose be halved for patients who receive other drugs with CNS depressant effects; for the buprenorphine transdermal patch, start with the 5 mcg/hour patch. It should be noted that the combination of buspirone and benzodiazepines can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. share. Serotonin syndrome is characterized by the rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. Mirtazapine: (Moderate) Although unlikely to occur with use of mirtazapine alone, there have been rare case reports of serotonin syndrome with the drug. Buspirone is a sensitive CYP3A4 substrate and lorlatinib is a moderate CYP3A4 inducer. Pregabalin: (Moderate) Concomitant administration of pregabalin with CNS depressant drugs, including buspirone, can potentiate the CNS effects of either agent. If a patient has been titrated to a stable dosage of buspirone, a dose adjustment of buspirone may be necessary to avoid adverse events attributable to buspirone. Dosage adjustments of either or both medications may be necessary. Lopinavir; Ritonavir: (Major) When buspirone is administered with a potent inhibitor of CYP3A4 like ritonavir, a low dose of buspirone used cautiously is recommended. After oral administration, buspirone is rapidly and almost completely absorbed, but only about 4% of a dose reaches systemic circulation because of extensive first-pass metabolism in the liver. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. Buspirone (flexible dosage, 20-60 mg/day) or placebo was added to the SSRI for 4 weeks; the mean daily dose of buspirone at endpoint was 48.5 mg (SD = 1.0). Aspirin, ASA: (Minor) In vitro studies showed that therapeutic levels of aspirin, ASA increased the plasma concentrations of free buspirone by 23% through plasma protein binding displacement. Acetaminophen; Aspirin, ASA; Caffeine: (Minor) In vitro studies showed that therapeutic levels of aspirin, ASA increased the plasma concentrations of free buspirone by 23% through plasma protein binding displacement. Dosage adjustments may be necessary if ziconotide is used with buspirone. Cases of serotonin syndrome have been reported, primarily following administration of standard infusions of methylene blue (1 to 8 mg/kg) as a visualizing agent in parathyroid surgery, in patients receiving selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or clomipramine. Diphenhydramine; Phenylephrine: (Moderate) The combination of buspirone and other CNS depressants, such as sedating h1-blockers, can increase the risk for sedation. Atropine; Difenoxin: (Moderate) Concomitant use of CNS depressants, such as buspirone, can potentiate the effects of diphenoxylate/difenoxin, which may potentially lead to respiratory depression, CNS depression, sedation, or hypotensive responses. Dosing Modifications . (Moderate) When buspirone is administered with an inhibitor of CYP3A4 like lopinavir, a lower dose of buspirone is recommended. I almost feel somewhat sedated? In vivo interaction studies with these drugs have not been performed. Predictions regarding this interaction can be made based on the metabolic pathways of these drugs. Some patients receiving drugs that are potent inhibitors of CYP3A4 with buspirone have reported lightheadedness, asthenia, dizziness, and drowsiness. Lorlatinib: (Moderate) Monitor for decreased efficacy of buspirone if lorlatinib is added to a patient on a stable dosage of buspirone; a dose increase of buspirone may be needed to maintain anxiolytic activity. Ivosidenib: (Moderate) Monitor for loss of efficacy of buspirone during coadministration of ivosidenib; a buspirone dose adjustment may be necessary. In a study in healthy volunteers, co-administration of buspirone with a potent CYP3A4 inducer decreased the plasma concentrations (83.7% decrease in Cmax; 89.6% decrease in AUC) and pharmacodynamic effects of buspirone. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). The magnitude of this interaction may be increased in patients who are also receiving cyclosporine. If hydrocodone is used with buspirone, the dose of one or both drugs should be reduced. Administering cobicistat with buspirone may increase buspirone concentration and risk for adverse events. Ciprofloxacin: (Moderate) Close clinical monitoring is recommended if buspirone is administered with ciprofloxacin; buspirone dose reductions may be required. Patients receiving this combination should be monitored for the emergence of serotonin syndrome or other adverse effects. Buspirone is a CYP3A substrate, and lesinurad is a weak CYP3A inducer. Haloperidol: (Moderate) Monitor for adverse effects, such as excess sedation and QT prolongation, during coadministration of buspirone and haloperidol. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The recommended initial dose is 15 mg daily (7.5 mg b.i.d.). Food: (Major) Buspirone should be taken consistently with or without food because food decreases the presystemic clearance of buspirone. Subsequent dosage adjustments should be based on clinical response. Safety and efficacy have not been established; 60 mg/day PO has been suggested from published off-label use for anxiety. (Minor) In vitro studies showed that therapeutic levels of aspirin, ASA increased the plasma concentrations of free buspirone by 23% through plasma protein binding displacement. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) The combination of buspirone and other CNS depressants, such as sedating h1-blockers, can increase the risk for sedation. A low dose of buspirone is recommended if administered with significant CYP3A4 inhibitors. In vitro, buspirone exhibits highest affinity for serotonin (5-HT) type 1A receptors, moderate affinity for dopamine type 2 (DA2) receptors, and weak affinity for serotonin type 2 (5-HT2) receptors. Alternatively, conversion to buspirone therapy may require treatment overlap to allow for the downward titration of the benzodiazepine while buspirone takes effect. Ceritinib: (Moderate) A low dose of buspirone used cautiously is recommended when coadministered with ceritinib. Thalidomide: (Major) Avoid the concomitant use of thalidomide with anxiolytics, sedatives, and hypnotics due to the potential for additive sedative effects. Serotonin syndrome is characterized by the rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes (e.g., delirium or coma), and in rare cases, death. If serotonin syndrome is suspected, tricyclic antidepressants and concurrent serotonergic agents should be discontinued. Select one or more newsletters to continue. Subsequent dosage adjustments should be based on clinical response. Therefore, before starting therapy with buspirone, withdraw patients gradually from the benzodiazepine. Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Moderate) Theoretically, concurrent use of methylene blue and buspirone may increase the risk of serotonin syndrome. Levorphanol: (Moderate) Concomitant use of CNS depressants, such as buspirone, can potentiate the effects of levorphanol, which may potentially lead to respiratory depression, CNS depression, sedation, or hypotensive responses. If a patient has been titrated to a stable dosage on buspirone, a dose adjustment of buspirone may be necessary to maintain anxiolytic effect. Several other anti-retroviral protease inhibitors also inhibit CYP3A4, and these may interact with buspirone in a similar manner. Coadministration with other moderate CYP3A4 inhibitors increased buspirone exposure by 3.4 to 6-fold and was accompanied by increased buspirone-related adverse reactions. If concurrent use of morphine and buspirone is imperative, reduce the dose of one or both drugs. Maprotiline: (Moderate) CNS depressants should be combined cautiously with maprotiline because they could cause additive depressant effects and possible respiratory depression or hypotension.