Buspirone and Xanax (alprazolam) are medications used to treat anxiety.1 However, buspirone is not related to Xanax and is not a sedative. The advantage of buspirone is that it does not have the potential for abuse. Overuse can lead to unpleasant symptoms, such as nausea and headaches. Xanax has the advantage of only being used for anxiety as needed. The disadvantage of Xanax is that it can be addictive.
Key Differences Between Buspirone & Xanax
The key differences between buspirone and Xanax are that buspirone may take up to 2 weeks to begin working, whereas the effects of Xanax may be felt within 30 minutes to 3 hours.2,3 While buspirone may be used short-term or long-term, Xanax should only be used short-term. They are both medications for anxiety but are not interchangeable.
The key differences between buspirone and Xanax:
Conditions Treated
Buspirone is FDA-approved for the treatment of generalized anxiety disorder (GAD) in adults. It also has non-FDA-approved use for depression, schizophrenia, and central sleep apnea.4,5,6 FDA-approved means the drug has been shown in clinical trials to be safe and effective. Non-FDA-approved means the drug has not been approved by the FDA for a certain use, but smaller trials have shown safety and clinical benefit.
Xanax is FDA-approved short-term for GAD and as needed for panic attacks in adults. Xanax is also used off-label to prevent operational anxiety (such as anxiety leading up to surgery or medical imaging) and to treat depression, insomnia, premenstrual disorder, seizures, and alcohol withdrawal syndrome.7,8,9,10,11,12
Standard Dosages & Forms
Both buspirone and Xanax come as oral tablets.3 Buspirone is started at 7.5 mg twice daily. The medication may be increased every 2-3 days in increments of 5 mg, and should not exceed a total daily dose of 60 mg (30 mg twice daily). The tablets come scored (visible lines for cutting) as 5mg, 10 mg, 15 mg, and 30 mg.
Xanax is also provided as scored, oral tablets and comes as 0.25 mg, 0.5 mg, 1 mg, and 2 mg.2 It is provided as immediate and extended-release tablets and as an oral solution. For GAD, it is started at 0.25 mg – 0.5 mg three times daily. For panic disorder, it is started at 0.5 mg three times daily. Xanax may be increased or decreased every 3-4 days. It should not exceed 4 mg per day.
Side Effects
Since the drug acts on serotonin and dopamine, buspirone side effects are similar to selective serotonin reuptake inhibitors (SSRIs) and stimulants.3 Common side effects include dizziness, nausea, headaches, nervousness, lightheadedness, insomnia, and excitement. Other side effects include drowsiness, dizziness, and nervousness. Rare but severe side effects of buspirone include anger or hostility, confusion, muscle aches or pains, and sweating.
Since Xanax acts as a sedative, its side effects are similar to medications that that are used for surgical sedation.2 Common side effects include drowsiness, fatigue, and solemnness. In addition, Xanax may cause weight changes, incoordination, lightheadedness, and dry mouth. Serious but rare side effects of Xanax include shortness of breath, sedation, hallucinations, coma, and death.
The table below summarizes the key differences between buspirone versus Xanax: 2,3
| Key Components | Buspirone | Xanax |
|---|---|---|
| What is the generic name? | buspirone | alprazolam |
| What forms does it come in? | Oral tablet | Oral tablet (immediate- or extended release) and oral solution |
| What are the typical dosages? | 7.5 mg, 10 mg, or 15 mg twice daily, up to 30 mg twice daily | 0.25 mg, 0.5 mg, 1 mg, or 2 mg two to three times daily as needed |
| Who is approved to take it? | Adults with GAD | Adults with GAD or panic disorder |
| Is there risk of addiction? | No | Yes |
| Is there risk of withdrawal and dependence effects? | Yes | Yes |
| Is it a controlled substance? | No | Yes |
What Is Buspirone?
Buspirone is an anxiolytic that has high activity for serotonin receptors and moderate activity for dopamine receptors.3 Anxiolytics are medications used for the treatment of anxiety disorders and include multiple drug classes. Buspirone is the only one of its kind, so it does not fit into a drug class and is only referred to as an anxiolytic.
Buspirone Uses
Buspirone has been FDA-approved for short-term or long-term GAD.3 FDA-approved means a medication has shown in clinical trials that it is safe and effective for a certain use. Buspirone has not been studied in clinical trials for the treatment of social anxiety, phobia, or panic attacks. It is, also helpful for symptoms of depression caused by anxiety.
What Is Xanax?
Xanax (alprazolam) is a benzodiazepine that acts on gamma-aminobutyric acid (GABA) receptors to increase GABA in the brain and cause thought relaxation.2 Though not prescribed as a muscle relaxer, it also works in the body and can help ease muscle tension caused by anxiety. Xanax is often prescribed by doctors for anxiety over other benzodiazepines because of its quick onset and elimination from the body.
Xanax Uses
Xanax is used to treat GAD short-term and panic disorder with or without agoraphobia (fear of leaving one’s home or being in crowded places).2 Xanax can be used to “bridge” anxiety treatment while waiting for an SSRI to kick in for about 4 weeks. Patients may also use Xanax as needed for panic disorder, such as if you have a presentation or performance that makes you feel like you might pass out.
What Are Buspirone & Xanax Used to Treat?
Buspirone is FDA-approved for the treatment of GAD in adults. It also has non-FDA-approved uses for depression, schizophrenia, and central sleep apnea.4,5,6 FDA-approved means the drug has shown safety and efficacy in clinical trials. Non-FDA-approved means the drug has not been approved by the FDA for a certain use, but smaller trials have shown safety and a clear, clinical benefit.
Xanax is FDA-approved short-term for GAD and as needed for panic attacks in adults. Xanax is also used off-label to prevent operational anxiety and to treat depression, insomnia, premenstrual disorder, seizures, and alcohol withdrawal syndrome.7,8,9,10,11,12
The table below compares the medical and mental health conditions buspirone and Xanax are used to treat:2,3,4,5,6,7,8,9,10,11,12
| Condition | Buspirone | Xanax |
|---|---|---|
| Generalized Anxiety Disorder | Yes, FDA-approved | Yes, FDA-approved |
| Panic Disorder | No | Yes, FDA-approved |
| Depression | Yes, non FDA-approved | Yes, non FDA-approved |
| Schizophrenia | Yes, non FDA-approved | No |
| Central Sleep Apnea | Yes, non FDA-approved | No |
| Insomnia | No | Yes, non FDA-approved |
| Premenstrual Disorder | No | Yes, non FDA-approved |
| Seizures | No | Yes, non FDA-approved |
| Alcohol Withdrawal Syndrome | No | Yes, non FDA-approved |
Side Effects of Buspirone & Xanax
Side effects that can occur with buspirone and Xanax include dizziness, drowsiness, and fatigue.2,3 Other common side effects of buspirone include nausea, headache, excitement, and insomnia. Side effects that can also commonly occur with Xanax include incoordination, memory issues, constipation, and changes in appetite. Commonly experienced side effects are often mild, though some may require medical attention.
The table below compares the possible side effects of buspirone and Xanax*:2,3
| Side Effects | Buspirone | Xanax |
|---|---|---|
| Drowsiness | Yes | Yes |
| Dizziness | Yes | Yes |
| Fatigue | Yes | Yes |
| Incoordination | Yes | Yes |
| Insomnia | Yes | Yes |
| Headache | Yes | Yes |
| Constipation | Yes | Yes |
| Diarrhea | Yes | Yes |
| Lightheadedness | Yes | Yes |
| Excitement | Yes | Yes |
| Depression | Yes | Yes |
| Blurred Vision | Yes | Yes |
| Dry Mouth | Yes | Yes |
| Skin Rash | Yes | Yes |
| Weakness | Yes | Yes |
| Nausea | Yes | No |
| Nervousness | Yes | No |
| Decreased concentration | Yes | No |
| Anger/Hostility | Yes | No |
| Confusion | Yes | No |
| Stomach Distress | Yes | No |
| Vomiting | Yes | No |
| Muscle Aches or Pains | Yes | No |
| Numbness | Yes | No |
| Burning or Prickling Sensations | Yes | No |
| Tremor | Yes | No |
| Sweating/Clamminess | Yes | No |
| Irritability | No | Yes |
| Memory Impairment | No | Yes |
| Cognitive Disorder | No | Yes |
| Difficulty Speaking | No | Yes |
| Decreased Libido | No | Yes |
| Confusion | No | Yes |
| Increased Libido | No | Yes |
| Change in Libido (Not Specified) | No | Yes |
| Increased Salivation | No | Yes |
| Lowered Blood Pressure | No | Yes |
| Behavioral or Mental Inhibition | No | Yes |
| Talkativeness | No | Yes |
| Derealization | No | Yes |
| Increased appetite | No | Yes |
| Decreased appetite | No | Yes |
| Weight Gain | No | Yes |
| Weight Loss | No | Yes |
| Urination Difficulties | No | Yes |
| Menstrual DIsorders | No | Yes |
| Sexual Dysfunction | No | Yes |
| Inability to Urinate | No | Yes |
| Abnormal Involuntary Movement | No | Yes |
| Muscle Twitching | No | Yes |
| Anxiety | No | Yes |
| Sweating | No | Yes |
| Racing heartbeat | No | Yes |
*All medications, including anti-anxiety medications, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
Severe Side Effects & Allergic Reactions With Buspirone & Xanax
Drowsiness, dizziness, and antidepressant withdrawal syndrome are severe side effects of buspirone that may occur.2,3 Drowsiness and dizziness are common, but the likelihood of experiencing other severe side effects or allergic reactions with buspirone is rare. However, one should always be cautious when starting a drug that affects your mental state, as in when operating machinery or driving. If you experience severe side effects from buspirone or Xanax, talk to your doctor or pharmacist immediately.
Severe side effects that may occur from taking buspirone include:3
- Excessive drowsiness
- Dizziness
- Depression
- Anger or hostility
- Burning or prickling sensations
- Numbness
- Incoordination
Severe side effects that may occur from taking Xanax include:2
- Slowed breathing
- Sedation
- Hallucinations
- Rage, aggression, or hostile behavior
- Substance abuse, misuse, or addiction
- Coma
- Death
Warnings & Precautions for Buspirone & Xanax
Buspirone and Xanax should not be suddenly stopped.2,3 Since buspirone acts on serotonin and dopamine levels, withdrawal can cause restlessness, headaches, and irritability. Discontinuing Xanax abruptly can also lead to withdrawal syndrome. Symptoms include sweating, anxiety, hallucinations, delirium, and seizures. In addition, they can interact with alcohol, and these medications should not be taken during pregnancy or lactation.
Risks to consider when taking buspirone and Xanax include:2,3
- Interactions with alcohol: Anti-anxiety medications and alcohol can affect your cognitive and motor function. The combination of these two should be avoided.
- Use while pregnant or breastfeeding: Xanax can cause neonatal withdrawal syndrome and buspirone has not been studied in humans during pregnancy or lactation.
- Benzodiazepine withdrawal: Abruptly stopping and drastically reducing your dose of Xanax can result in benzodiazepine withdrawal.
- Interactions with opioids: Xanax has a warning for severe interaction with opioids. The combination should be avoided, as breathing may be impaired, leading to coma or death.
Potential Food & Drug Interactions With Buspirone & Xanax
Buspirone and Xanax can interact with certain foods, substances, and medications2,3, so it’s important to speak with your doctor about your lifestyle to make sure that these medications are safe for you. Anti-anxiety medications can interact with substances like alcohol and other medications, increasing the risk of side effects. Buspirone and Xanax can affect your cognitive function, and if interactions enhance this, it can be dangerous.
Disclaimer: Taking certain medications, herbs, or supplements alongside buspirone and Xanax can change how these medications work in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Medications and substances that have harmful interactions with buspirone and Xanax include:2,3
| Complicating Interactions | Buspirone | Xanax |
|---|---|---|
| Phenytoin, phenobarbital, and carbamazepine | X | X |
| Grapefruit juice | X | X |
| Alcohol | X | X |
| Amitriptyline, trazodone, and haloperidol | X | X |
| Erythromycin and clarithromycin | X | X |
| Itraconazole and Ketoconazole | X | X |
| Rifampin | X | |
| Ritonavir | X | |
| Monoamine Oxidase Inhibitors (MAOIs) | X | |
| Dexamethasone | X | |
| Selective serotonin reuptake inhibitors (SSRIs) | X | |
| Diltiazem and Verapamil | X | |
| Digoxin | X | |
| Antihistamines | X | |
| Muscle relaxants | X | |
| Opioids | X |
Buspirone & Xanax: Key Pros & Cons
The advantage of both buspirone and Xanax is that they are relatively inexpensive. Also, most insurance plans and Medicare cover both. In addition, both are small, oral tablets and easy to take. The disadvantage is that both can make you drowsy.
Pros & Cons of Buspirone
The advantages of buspirone include that it is less likely to make you drowsy. Also, buspirone does not have a chance of addiction and is considered safer with less serious side effects. The disadvantages of buspirone include that it is only approved for GAD. Also, you may have to try several medications before your insurance will approve it, and since it has a couple of mechanisms, it can have many side effects.
Pros & Cons of Xanax
The advantages of Xanax include that it is approved for multiple uses, such as GAD and panic disorder. Xanax has a strong sedative effect. Xanax also comes in extended-release and solution formulations. An added benefit is that Xanax may also help with insomnia, a common issue to have with anxiety.
A disadvantage of Xanax is the risk of addiction and also some serious side effects. Certain medical problems, such as lung disease, increase the risk of serious side effects. Severe side effects with Xanax may also occur if you take other drugs that can impact your breathing and alertness, such as alcohol, opioids, or muscle relaxers.
Which Is Right for You: Buspirone or Xanax?
In general, buspirone is more appropriate for patients with anxiety that don’t want to worry about addiction. Though a common side effect, buspirone is also less likely to make you drowsy. Xanax is better for patients that also have panic disorder or need a drug that is more sedating.
The medication best for your needs can depend on many factors. Factors include uses, formulations, your medical history, other medications you are on, and side effects. So, you may need to consider online psychiatry services if seeing a doctor in person isn’t feasible. They can help you consider the benefits and risks of each medication.
How to Get a Prescription for Buspirone & Xanax
Buspirone and Xanax are available by prescription only. You can discuss the risks and benefits of taking anti-anxiety medication with your doctor and how to get anxiety medication. Your primary care provider or nurse practitioner may provide you with Xanax in addition to an SSRI. However, you should typically see a psychiatrist if you have mental health concerns, to determine your best course of action.
Buspirone and Xanax are typically used as anxiety medications, but they aren’t considered first-line agents. Often, SSRIs, SNRIs, or TCAs are considered as well. Buspirone is considered after these medications because of how many side effects it has and their occurrence. Xanax is considered after these medications also due to its side effects’ occurrence and its risk for severe side effects.
Questions to Ask Your Health Team About Buspirone & Xanax
It is important to have open communication with your doctor so can accurately decide which medication is best for you. It is also important to talk with them about your lifestyle because these medications can be very dangerous. It is also important to talk with them about your lifestyle because there are some dangerous interactions with alcohol. Also, you should go to your appointment prepared with any questions or concerns you have.
Questions to ask your prescriber about buspirone and Xanax include:
- Is it safe to take buspirone or Xanax with my other medications?
- Will buspirone or Xanax be covered by my insurance?
- Which one has the best results as a treatment for anxiety?
- Does my medical history increase my risk of side effects for either?
- How long can I expect side effects to last?
- How often should I see you for checkups while taking buspirone or Xanax?
- What should I do if I am unsure whether anti-anxiety medications are right for me?
In My Experience
In my experience, patients do not typically have a problem taking buspirone or Xanax besides having mild side effects. It’s important to talk to your doctor about this topic and follow their guidance because Xanax can become a problem if not used correctly. So, it’s very important to only use Xanax as prescribed. Low doses are safest, but if you do develop an addiction to Xanax, it is possible to safely get treatment for the addiction. Talk to your doctor or pharmacist so they can help give you support.
