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Anxiety is a common type of mental health condition, and there are many different treatment options available. Both buspirone and Xanax can be effective in treating anxiety symptoms. Still, there are differences between how these medications work and their possible side effects.
What are buspirone and Xanax?
Both buspirone (see Important Safety Information) and Xanax are medications approved by the U.S. Food and Drug Administration (FDA) to treat anxiety. They both fall within the category of anxiolytics, a group of drugs primarily used to treat anxiety.
Even though both medications treat some of the same medical conditions, they are very different drugs.
What is buspirone?
Buspirone is the generic name for a medication that used to be available under the brand name Buspar. Buspirone is an anti-anxiety medication that was initially created as an antipsychotic medication. However, researchers found it worked better at relieving anxiety symptoms than symptoms of psychosis.
Buspirone activates serotonin and dopamine receptors in the brain. Because these neurotransmitters play a role in regulating anxiety symptoms, activating their receptors in the brain can help to manage anxiety (Wilson, 2020).
What is Xanax?
Xanax is a brand-name medication that falls within the class of medication called benzodiazepines. The generic name for this medication is alprazolam.
Benzodiazepines help the neurotransmitter gamma-aminobutyric acid (GABA) bind to its receptors in the brain and central nervous system (CNS). This increases the effectiveness of GABA, which bumps up sedation and muscle relaxation while reducing anxiety (George, 2020).
Differences between buspirone and Xanax
The main difference between buspirone and Xanax is the chemical difference between the two. They have entirely different mechanisms of action and affect separate neurotransmitters.
Let’s review a few other differences (Wilson, 2020; George, 2020):
Similarities between buspirone and Xanax
The primary similarity between buspirone and Xanax is they both fall within the broad category of anxiety-fighting medications. There is also a risk of becoming dependent on these medications. However, buspirone has a much lower likelihood of addiction than Xanax (Wilson, 2020).
Conditions treated by buspirone and Xanax
Both medications are FDA-approved to treat anxiety disorders, but providers can also use them “off-label” to treat other mental health conditions, meaning the FDA didn’t explicitly approve it for those uses. Healthcare providers can prescribe drugs for an unapproved use if they decide that it’s the correct treatment for their patients.
Here are the approved and off-label uses of these medications:
FDA-approved uses of buspirone include (Wilson, 2020):
- Short-term and long-term treatment of generalized anxiety disorder (GAD)
Off-label uses include:
- Reducing sexual side effects of selective serotonin reuptake inhibitors (SSRIs)
- Pediatric anxiety disorders
FDA-approved uses of Xanax include (George, 2020):
- Anxiety disorders
- Panic disorders and panic attacks
Off-label uses include:
- Premenstrual syndrome
Dosing for buspirone vs. Xanax
Your healthcare provider will help you determine the best dose for you. Common doses include:
Buspirone is available in oral tablets ranging from 5 mg to 30 mg.
Depression: symptoms, causes, diagnosis, and treatment
The initial dose to treat generalized anxiety disorder is usually 15 mg per day administered in 7.5 mg twice daily or 5 mg three times daily. Your healthcare provider may then increase your dose to reach desired symptom management. The typical range is between 20–30 mg total per day, with a maximum daily dose of 60 mg (Wilson, 2020).
Alprazolam is available in tablets, disintegrating pills, and liquid forms. The typical dose for most adults is between 0.25 and 0.5 mg three times each day. Your healthcare provider will slowly increase your dose to the desired effect. The maximum dose is 4 mg per day (George, 2020).
Effectiveness of buspirone vs. Xanax
Both medications are equally as effective at treating generalized anxiety disorder (Dimitriou, 2012).
Your healthcare provider will help you find the best medication for your needs based on your:
- Medical conditions
- Psychiatric history
- Response to the drug (its effectiveness at managing your anxiety symptoms, and whether you develop any side effects)
All medications have the potential to cause side effects. Your healthcare provider will help you weigh the possible benefits and risks of your treatment options.
Buspirone side effects
Research shows buspirone has a lower risk for causing side effects, dependency, and withdrawal symptoms than Xanax (Wilson, 2020).
Anxiety: types, symptoms, causes, and treatments
The most common side effect is dizziness, which affects over 10% of people. Less common side effects of buspirone include (Wilson, 2020):
- Abnormal dreams
- Ataxia (impaired balance, coordination, and muscle control)
- Nervousness, outbursts of anger, or excitement
- Blurred vision
- Chest pain
- Nasal congestion
- Diarrhea and nausea
- Muscle pain, tremor, or weakness
- Skin rash
Most of the side effects resolve over time. Your healthcare provider can mitigate them with a gradual increase in the dose rather than a quick jump in the dose.
Xanax side effects
Common side effects of alprazolam include (George, 2020):
- Drowsiness or tiredness
- Dizziness and trouble concentrating
- Trouble sleeping or insomnia
- Memory problems
- Poor balance or coordination
- Slurred speech
- Diarrhea and constipation
- Nausea, vomiting, and upset stomach
- Blurred vision
- Appetite or weight changes
- Swelling of hands or feet
- Muscle weakness
- Dry mouth
- Stuffy nose
- Low sex drive
Other medications can alter the effectiveness of buspirone and Xanax, making them more or less effective.
You should take neither medication with alcohol, depressants, sedatives, or opioids because of an increased risk for respiratory distress, sedation, and possibly even death.
Buspar and alcohol: risks and side effects
Buspirone shouldn’t be taken within 14 days of taking a monoamine oxidase inhibitor (MAOI). This combination could lead to a condition called serotonin syndrome (Wilson, 2020).
Do not drink grapefruit juice while taking buspirone or Xanax. Grapefruit juice affects the enzymes used to break down these medications, increasing their effectiveness and the risk for adverse effects.
The following medications may alter the effectiveness of alprazolam (George, 2020):
- Antianxiety and sedative medications such as diazepam (Valium) and clonazepam (Klonopin)
- Azole antifungals, such as ketoconazole and itraconazole
- Some types of antidepressants, such as fluoxetine (see Important Safety Information), fluvoxamine, sertraline (see Important Safety Information), and nefazodone
- Some types of antibiotics, such as clarithromycin, erythromycin
- Rifamycins (rifampin)
- St. John’s Wort
- Seizure medications such as carbamazepine, phenytoin, lorazepam (Ativan)
- Muscle relaxants
- Oral contraceptives
This is not a complete list of drug interactions. Let your healthcare provider know about any other medications or supplements you are taking.
Do I have anxiety? Types of anxiety and how to treat it
Many drugs come with warnings from the FDA. It’s important to be aware of these before taking any new medication.
Warnings for buspirone include (Wilson, 2020):
- Drinking alcohol while taking buspirone may increase its effectiveness, leading to adverse side effects.
- Do not drive or operate heavy machinery until you know how buspirone affects you.
- Buspirone may not be safe during pregnancy. Talk with your healthcare provider if you are or become pregnant.
Warnings while taking Xanax include (George, 2020):
- Alprazolam may be habit-forming and risk addiction, especially when taken at higher doses, using long-term, or in people with a history of substance abuse.
- Do not stop the use of alprazolam without talking with your healthcare provider first. There is a risk for withdrawal symptoms when stopping Xanax. Your healthcare provider will help you wean off the medication to reduce withdrawal risk.
- Xanax is not considered safe while pregnant or breastfeeding because it may cause congenital abnormalities and lead to withdrawal symptoms and excessive drowsiness in infants.
Both of these medications can be useful for treating anxiety disorders. Talk with your healthcare provider about which option is a better fit for you.
- Dimitriou, E.C., Parashos, A.J. & Giouzepas, J.S. (2012). Buspirone vs alprazolam: a double-blind comparative study of their efficacy, adverse effects and withdrawal symptoms. Drug Invest 4, 316–321 (1992). doi: 10.1007/BF03259411. Retrieved from https://link.springer.com/article/10.1007/BF03259411
- George TT, Tripp J. (2020). Alprazolam. [Updated Jul 19, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538165/
- Wilson TK, Tripp J. (2020). Buspirone. [Updated Aug 12, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531477/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.