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Buspirone is an anxiolytic drug. Originally, the drug was developed as an antipsychotic but was found ineffective for psychosis, but it had useful anxiolytic features. Buspirone has recently come into favor, primarily due to its decreased side-effect profile compared to other anxiolytic treatments. Buspirone is primarily used to treat generalized anxiety disorder. It is a United States Food and Drug Administration-approved medicine for managing anxiety disorders or the short-term relief of anxiety symptoms. Off-labeled buspirone is used for the augmentation of unipolar depression. This activity reviews the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring of buspirone, pertinent for interprofessional team members for treating patients where buspirone is indicated. Objectives: Describe the mechanism of action of buspirone. Outline the indications for initiating buspirone. Summarize the contraindications associated with initiating buspirone. Review interprofessional team strategies for improving care coordination and communication to advance the use of buspirone and improve outcomes in disorders where indicated. Access free multiple choice questions on this topic.

Relative to other anxiolytics, buspirone has low toxicity and potential for abuse. There have been no deaths reported from a buspirone overdose alone. In pharmacological trials, healthy male patients were given up to 375 mg daily and developed nausea, vomiting, dizziness, drowsiness, miosis, and gastric distress. While buspirone overdose typically resolves with complete recovery, high suspicion of other medication overdoses should be maintained and investigated.[29][30] In a literature review, multiple reports of movement disorders, including dyskinesia, akathisia, myoclonus, parkinsonism, and dystonia, have been reported. In case of movement disorder induced by buspirone, the drug should be discontinued, and in some instances, it may require therapy with trihexyphenidyl/benztropine(centrally acting anticholinergic medication) and additional supportive treatment.[19] Clinicians should use symptomatic and supportive measures and immediate gastric lavage in acute overdose. Healthcare providers must monitor respiration, pulse, and blood pressure, as in all drug overdose cases. Seizures can occur in rare instances which require treatment with benzodiazepines. It is important to note that no specific antidote is known for buspirone.[31]

Before initiating buspirone therapy, it is essential to understand proper indications, dosing, adverse drug reactions, and toxicity. The clinician should prescribe buspirone and counsel the patient on the risk vs. benefit ratio. The pharmacist must educate the patient on the safe use of the drug and ensure proper dosing. Additionally, the pharmacist must communicate with the physician if there is evidence of drug misuse in rare instances. In an era where drug abuse results in high mortality, healthcare workers are responsible for ensuring that patients only use buspirone for legitimate purposes. The literature review suggests that buspirone has negligible abuse potential.[32] Nurses should monitor for the signs and symptoms of anxiety during each follow-up visit. Nursing staff can also provide patient counseling to reinforce the pharmacists' advice. Residents and medical students should counsel the patient not to combine buspirone with other sedatives or alcohol. Patients who continue to get refills should be encouraged to seek counseling from a psychiatrist. Encourage individuals to be patient at the initiation of therapy and follow up within a month to assess the effectiveness of buspirone therapy. The attending psychiatrist should evaluate the patient regularly and share their findings with the healthcare team. For example, emergency physicians and triage nurses should establish patent airway, breathing, and circulation in an overdose of buspirone. Moreover, the emergency department physician should notify the psychiatrist if the overdose is deliberate. Healthcare professionals should use evidence-based medicine and be well-informed about the latest guidelines regarding the current status of buspirone in treating generalized anxiety disorder.[33] As depicted above, clinicians, specialists, nurses, pharmacists, and other healthcare providers should closely collaborate with the patient on buspirone therapy. An interprofessional team approach can achieve optimal therapeutic results with minimal adverse effects leading to better patient outcomes. A systematic review and meta-analysis of seven randomized controlled trials concluded that interprofessional care and communication between clinicians, psychiatrists, specialty-trained nurses, and psychologists could significantly improve patient outcomes in anxiety disorders.[34]