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  • Buspirone Vs XanaxBuspirone Vs Xanax
  • What Is Buspirone?What Is Buspirone?
  • What Is Xanax?What Is Xanax?
  • UsesUses
  • Side EffectsSide Effects
  • Warnings & PrecautionsWarnings & Precautions
  • Potential Food & Drug InteractionsPotential Food & Drug Interactions
  • Pros & ConsPros & Cons
  • Which Is Best?Which Is Best?
  • How to Get a PrescriptionHow to Get a Prescription
  • Questions to AskQuestions to Ask
  • In My ExperienceIn My Experience
  • Additional ResourcesAdditional Resources

Buspirone Vs Xanax: Differences, Similarities, & Which to Take

Headshot - Christin Black, PharmD

Author: Christin Black, PharmD

Headshot - Christin Black, PharmD

Christin Black PharmD

Christin Black is an experienced pharmacist and an expert in behavioral health medication. Her areas of expertise include ADHD, anxiety, bipolar disorder, depression, and OCD.

See My Bio Editorial Policy
Headshot of Heidi Moawad, MD

Medical Reviewer: Heidi Moawad, MD Licensed medical reviewer

Headshot of Heidi Moawad, MD

Heidi Moawad MD

Heidi Moawad, MD is a neurologist with 20+ years of experience focusing on
mental health disorders, behavioral health issues, neurological disease, migraines, pain, stroke, cognitive impairment, multiple sclerosis, and more.

See My Bio Editorial Policy
Published: June 5, 2023
  • Buspirone Vs XanaxBuspirone Vs Xanax
  • What Is Buspirone?What Is Buspirone?
  • What Is Xanax?What Is Xanax?
  • UsesUses
  • Side EffectsSide Effects
  • Warnings & PrecautionsWarnings & Precautions
  • Potential Food & Drug InteractionsPotential Food & Drug Interactions
  • Pros & ConsPros & Cons
  • Which Is Best?Which Is Best?
  • How to Get a PrescriptionHow to Get a Prescription
  • Questions to AskQuestions to Ask
  • In My ExperienceIn My Experience
  • Additional ResourcesAdditional Resources
Christin Black, PharmD headshot
Written by:

Christin Black

PharmD
Headshot of Benjamin Troy, MD
Reviewed by:

Heidi Moawad

MD
Generic name:
Buspirone
Brand name:
None
Is the generic available:
Yes
Class of drug:
Antianxiety
FDA-approved treatments:
Anxiety symptoms
Common Off-label Uses (non-FDA approved):
Major depressive disorder, unipolar depression, sleep problem, sexual side effect, pediatric anxiety disorders
Common alternatives:

Lexapro, Cymbalta, Xanax

View Drug Class, FDA-Approved Uses, Off-Label Uses, and more

*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.

Brand name:
Xanax
Generic name:
Alprazolam
Is the generic available:
Yes
Class of drug:
Benzodiazepine
Boxed warning:
Yes
FDA-approved treatments:
Generalized Anxiety Disorder, Panic Disorder
Common Off-label Uses (non-FDA approved):
Insomnia, Depression, Premenstrual Dysphoric Disorder (PMDD)
Common alternatives:

Klonopin, Valium, Ativan

View Drug Class, FDA-Approved Uses, Off-Label Uses, and more

*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.

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.

If you’re considering a prescription for buspirone or Xanax or want to discuss your current prescription with a provider, an online psychiatry platform is a good place to start. Platforms like Talkiatry and Brightside Health can connect you with a provider quickly and offer assessments and prescription consultation.

Boxed Warning: Risks of Alprazolam (Xanax) include misuse, addiction, withdrawal and even death

Click here to open and close the box warning container.

Alprazolam, the active ingredient in Xanax, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA).

  • Taking Xanax, a benzodiazepine, with other opioid medications increases your risk for serious side effects that include severe sedation, slower breathing, coma, and death. Xanax should not be taken with an opioid unless there are no other options.
  • Taking Xanax can lead to misuse (abuse) and addiction of the medication, which can increase your risk of overdose and death.
  • Using Xanax can lead to physical dependence and this risk increases the longer you take Xanax. If you suddenly stop taking Xanax, you can experience withdrawal. Withdrawal can be life threatening. Xanax should only be discontinued by gradual tapering of the dose.

Xanax is a controlled substance, which means that it’s more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.

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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, Xanax dosage 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 ComponentsBuspironeXanax
What is the generic name?buspironealprazolam
What forms does it come in?Oral tabletOral 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 daily0.25 mg, 0.5 mg, 1 mg, or 2 mg two to three times daily as needed
Who is approved to take it?Adults with GADAdults with GAD or panic disorder
Is there risk of addiction?NoYes
Is there risk of withdrawal and dependence effects?YesYes
Is it a controlled substance?NoYes

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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

ConditionBuspironeXanax
Generalized Anxiety DisorderYes, FDA-approvedYes, FDA-approved
Panic DisorderNoYes, FDA-approved
DepressionYes, non FDA-approvedYes, non FDA-approved
SchizophreniaYes, non FDA-approvedNo
Central Sleep ApneaYes, non FDA-approvedNo
InsomniaNoYes, non FDA-approved
Premenstrual DisorderNoYes, non FDA-approved
SeizuresNoYes, non FDA-approved
Alcohol Withdrawal SyndromeNoYes, non FDA-approved

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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 EffectsBuspironeXanax
DrowsinessYesYes
DizzinessYesYes
FatigueYesYes
IncoordinationYesYes
InsomniaYesYes
HeadacheYesYes
ConstipationYesYes
DiarrheaYesYes
LightheadednessYesYes
ExcitementYesYes
DepressionYesYes
Blurred VisionYesYes
Dry MouthYesYes
Skin RashYesYes
WeaknessYesYes
NauseaYesNo
NervousnessYesNo
Decreased concentrationYesNo
Anger/HostilityYesNo
ConfusionYesNo
Stomach DistressYesNo
VomitingYesNo
Muscle Aches or PainsYesNo
NumbnessYesNo
Burning or Prickling SensationsYesNo
TremorYesNo
Sweating/ClamminessYesNo
IrritabilityNoYes
Memory ImpairmentNoYes
Cognitive DisorderNoYes
Difficulty SpeakingNoYes
Decreased LibidoNoYes
ConfusionNoYes
Increased LibidoNoYes
Change in Libido (Not Specified)NoYes
Increased SalivationNoYes
Lowered Blood PressureNoYes
Behavioral or Mental InhibitionNoYes
TalkativenessNoYes
DerealizationNoYes
Increased appetiteNoYes
Decreased appetiteNoYes
Weight GainNoYes
Weight LossNoYes
Urination DifficultiesNoYes
Menstrual DIsordersNoYes
Sexual DysfunctionNoYes
Inability to UrinateNoYes
Abnormal Involuntary MovementNoYes
Muscle TwitchingNoYes
AnxietyNoYes
SweatingNoYes
Racing heartbeatNoYes

*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

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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: Using Xanax during pregnancy and breastfeeding may be risky. 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 InteractionsBuspironeXanax
Phenytoin, phenobarbital, and carbamazepineXX
Grapefruit juiceXX
AlcoholXX
Amitriptyline, trazodone, and haloperidolXX
Erythromycin and clarithromycinXX
Itraconazole and KetoconazoleXX
RifampinX
RitonavirX
Monoamine Oxidase Inhibitors (MAOIs)X
DexamethasoneX
Selective serotonin reuptake inhibitors (SSRIs)X
Diltiazem and VerapamilX
DigoxinX
AntihistaminesX
Muscle relaxantsX
OpioidsX

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.

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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?
  • What are some Xanax alternatives to consider?

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.

Headshot - Christin Black, PharmD Christin Black, PharmD

Sources

ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

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