Buspirone vs Xanax (Alprazolam): Differences and Similarities

Buspirone and Xanax (alprazolam) are prescription drugs used to treat anxiety disorders in adults.

While both are equally effective for anxiety, buspirone and Xanax differ in how they work in the body, their associated side effects, their addictive potential, and more.

For example, Xanax is usually preferred for short-term use as it starts working quickly within the first week of treatment. However, it can cause drowsiness and sedation.

On the other hand, buspirone provides gradual and continuous improvement but can cause appetite disturbance and abdominal discomfort.

This article compares buspirone and Xanax. Review each of their uses, mechanisms of action, dosages, formulations, and how fast and how long they work for anxiety.

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Boxed warnings

  • Combining Xanax with opioids, alcohol, or other central nervous system (CNS) depressants (including street drugs) can cause severe drowsiness, excessive sleepiness, or slow or stop breathing.
  • Xanax is a controlled substance. Misuse of this drug can lead to addiction, overdose, or death. It is possible to develop an addiction even if you take the drugs prescribed by your doctor. Therefore, it is important to keep the drug in a safe place where others cannot access it.
  • Abruptly stopping use can result in life-threatening withdrawal symptoms that can last for months. Talk to your doctor about safely taking yourself off your Xanax regimen, if needed.

What are the main differences between Buspirone and Xanax?

Xanax and buspirone both treat anxiety disorders in adults.

Xanax, a benzodiazepine, binds to gamma-aminobutyric acid (GABA) receptors in the brain, while buspirone binds to serotonin and dopamine receptors, although its exact method of action is not fully understood. Buspirone, which is not a benzodiazepine, does not cause significant sedation.

Xanax and buspirone are both approved to manage anxiety disorders and relieve anxiety symptoms. Xanax, however, can also treat panic disorders with or without agoraphobia.

Xanax should only be used short-term, as it addresses the symptoms of anxiety, not the underlying causes. For long-term use, buspirone is a more appropriate option.

Xanax (alprazolam)

  • Used to manage anxiety disorders or relieve anxiety symptoms; it also treats panic disorder

  • Available generically or under the brand names Xanax and Xanax XR

  • Available as tablets in strengths of 0.25 mg, 0.5 mg, 1 mg and 2 mg

  • Provides faster symptom relief (within a week).

  • Increased risk of addiction

Buspirone

  • Used to manage anxiety disorders or relieve anxiety symptoms

  • Generally available; Buspar brand no longer available

  • Available as tablets in strengths of 5 mg, 7.5 mg, 10 mg, 15 mg and 30 mg

  • Provides a more gradual and continuous improvement of symptoms

  • Lower risk of addiction

Buspirone vs Xanax: Off-label uses

Healthcare professionals may prescribe drugs for conditions they are not licensed to treat if there is evidence that they may help. This is known as off-label use.

Xanax is occasionally prescribed off-label to treat anxiety in children.

Meanwhile, buspirone can be used off-label to treat anxiety in children or with other medicines to treat depression.

Is Buspirone or Xanax more effective?

Studies show that buspirone and Xanax are equally effective in treating anxiety and its symptoms.

A four-week study included 60 people with generalized anxiety disorder treated with one of three drugs: buspirone, alprazolam or lorazepam. All of these drugs produced similarly significant reductions in anxiety by the end of the study.

Another study comparing buspirone and Xanax for six weeks in 94 people had similar results in how well they reduced anxiety symptoms. However, the study found significant differences in how quickly each worked.

Xanax provided improvement within the first week of the study, and buspirone showed more gradual and continuous improvement throughout the study. Buspirone typically takes two to four weeks to fully reduce anxiety symptoms.

What are the Side Effects of Buspirone vs. Xanax?

Both Xanax and buspirone have the potential to cause side effects. However, Xanax is more likely to cause drowsiness, lethargy, and fatigue.

Buspirone, on the other hand, may be more likely to cause gastrointestinal-related side effects, such as changes in appetite or stomach upset.

Common side effects

The side effects listed below are more common with the use of Xanax and buspirone.

Xanax

  • Drowsiness

  • Fatigue

  • Impaired coordination

  • Irritability

  • Altered concentration

  • Difficulty speaking

  • Confusion

  • Decreased sex drive (libido)

  • Constipation

  • Dry mouth or excessive saliva

  • Rash

  • Appetite changes

  • Dizziness

  • Insomnia (trouble sleeping)

  • Heachache

  • Menstrual irregularities

Buspirone

  • Dizziness

  • Drowsiness

  • Nervousness

  • Insomnia

  • Altered concentration

  • Hostility

  • Confusion

  • Nausea

  • Abdominal pain

  • Diarrhea

  • Blurred vision

  • Numbness

  • Heachache

  • Excitement

Serious side effects

The following side effects of Xanax and buspirone can be serious and potentially life-threatening. Tell your doctor straight away if you notice any of these side effects appearing or getting worse.

Xanax

  • Angioedema (swelling under the skin)

  • Addiction or abuse

  • Fast heart rate

  • Liver damage

  • Low blood pressure (hypotension)

  • Respiratory depression (when used with other benzodiazepines or opioids)

  • Convulsions

  • Stevens-Johnson syndrome, a rare skin disease

  • Withdrawal symptoms following abrupt discontinuation

What is the dosage of Buspirone compared to Xanax?

Below are general dosage recommendations for buspirone and Xanax. However, it is always best to follow your doctor’s instructions on the correct dosage for you.

  • Xanax for anxiety: To treat anxiety, Xanax is usually prescribed 0.25 milligram (mg) to 0.5 milligram three times a day. The dosage may be gradually increased every three to four days, up to a maximum recommended daily dose of 4 milligrams. The maximum daily dose is 10 milligrams.
  • Xanax for panic disorder: To treat panic disorder, extended-release Xanax may initially be prescribed at 0.5 milligram three times a day. The dosage may be increased gradually every three to four days, but no more than 1 milligram per day. The maximum daily dose is 10 milligrams.
  • Buspirone for anxiety: The starting dosage is 10 milligrams to 15 milligrams per day in two or three divided doses. The dosage may be gradually increased by 5 milligrams every two to three days as needed. The typical dosage range is 20 to 30 milligrams per day in two or three divided doses. It is important not to exceed a maximum daily dose of 60 milligrams.

Drug Interactions of Buspirone and Xanax

Taking Xanax with other drugs that make you drowsy or slow your breathing can cause dangerous side effects or death. Avoid combination with the following:

  • Opioids
  • Other CNS depressants such as alcohol, seizure medications, and psychotropic drugs
  • CYP3A inhibitors (except ritonavir), such as ketoconazole and Sporanox (itraconazole)
  • CYP3A inducers, such as Luvox (fluvoxamine) and erythromycin

Ask your doctor before using opioid medications, sleeping pills, muscle relaxers, or medicine for anxiety or seizures.

Tell your doctor about all medicines you are taking. Many medications can affect buspirone.

You shouldn’t take buspirone within 14 days of taking MAOIs, such as Nardil (phenelzine) and Parnate (tranylcypromine). This can increase the risk of serotonin syndrome.

Other interactions that can occur with buspirone:

  • St. John’s wort
  • Antibiotics, such as erythromycin and rifampin
  • Antifungal drugs, such as itraconazole and ketoconazole
  • Certain heart or blood pressure medications, such as Cardizem (diltiazem) and Verelan (verapamil)
  • Certain medications for seizures, including Tegretol (carbamazepine), Dilantin (phenytoin), and phenobarbital
  • Monoamine oxidase (MAO) inhibitors, including Nardil (phenelzine) and Parnate (tranylcypromine)
  • Other drugs that induce or inhibit CYP3A4, such as nefazodone, Norvir (ritonavir), and dexamethasone

Also, avoid alcohol and drink large quantities of grapefruit juice.

Who shouldn’t take Buspirone vs Xanax?

Both Buspirone and Xanax come with various safety warnings. Depending on certain health considerations, you may need to avoid taking one of these medications altogether.

Xanax

You should avoid taking Xanax:

  • With opioids, alcohol, and other CNS depressants, this combination can cause severe drowsiness, excessive sleepiness, shallow or slow breathing, or coma.
  • During pregnancy.
  • If you are taking certain medications, such as strong CYP3A inhibitors (e.g. azole antifungals).

Talk to your doctor about special precautions to take with Xanax if:

  • Have a history of substance abuse or addiction.
  • Have a history of depression.

Buspirone

You should avoid taking buspirone:

  • If you are allergic to buspirone or any of its ingredients.
  • With any MAOI.
  • During pregnancy or breastfeeding.

Summary

Buspirone and Xanax are two common medications used to manage anxiety.

Studies show that buspirone and Xanax are equally effective in treating anxiety and its symptoms. However, they differ in the time they take to work, associated side effects, and abuse potential.

In determining which medication is right for you, your doctor may consider several factors, such as your symptoms, medical history, and current medication use.

Frequent questions

  • Can Buspirone or Xanax be used while pregnant or breastfeeding?

    It is not recommended to use Xanax during pregnancy. Also, breastfeeding while taking Xanax is not recommended due to the risk of adverse reactions, including sedation and withdrawal symptoms, in breastfed infants.

    Buspirone should only be used during pregnancy if needed. You should not breastfeed while using buspirone.

    Tell your doctor if you become pregnant, plan to become pregnant, or are breastfeeding while taking any of these medications.

  • Does Buspirone or Xanax cost more?

    The cost of your medications depends on your insurance plan and whether you’re prescribed a brand name or generic version.

    Xanax, a brand-name drug, will likely cost more than generic buspirone. However, Xanax is also available generically as alprazolam.

  • How long do buspirone and Xanax take to work?

    Xanax is completely absorbed in one to two hours. It produces rapid relief of symptoms within the first week of treatment.

    Buspirone does not provide immediate relief. Anxiety symptoms such as restlessness may initially get worse before gradually improving over time. It typically takes two to four weeks for this drug to effectively reduce anxiety.

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