Buspirone vs. Xanax -What’s the Difference?

If you struggle with feelings of anxiety daily and find it difficult to manage them on your own, know that you’re not alone. According to the National Alliance on Mental Illness (NAMI), over 40 million American adults (19.1%) have an anxiety disorder. And approximately 7% of children aged between three and 17 experience anxiety issues each year. Fortunately, many treatment options are available to manage feelings of anxiety and improve their everyday life.

According to the National Center for Biotechnology Information (NCBI), buspirone and Xanax are two common FDA-approved medications used to treat generalized anxiety disorders. Although they both belong to the broad group of anxiolytic drugs and are equally efficient at alleviating anxiety symptoms, their mechanisms of action are unique.

This article hopes to highlight significant key differences between the two medications, their side effects, and other potential risks so that you may make an informed decision for your health and wellness.

Formerly known as Buspar, buspirone is an anti-anxiety medication primarily used to treat generalized anxiety disorder (GAD). Buspirone was initially developed as an antipsychotic medication. However, researchers later found that it worked better to relieve anxiety symptoms than psychosis. Buspirone has also recently come into favor due to its low side effect profile compared to other anxiolytic medications.

Buspar has a high bioavailability rate and is absorbed by the body at nearly 90%. It has a relatively short half-life of two to three hours and comes in various strengths. Oral tablets are available in 5 mg, 7.5 mg, 10 mg, 15 mg, and 30 mg. Healthcare providers usually start their patients with the lowest possible dose and then increase the dose to 20 mg or 30 mg daily. The recommended maximum dose is 60mg per day. Generic buspirone is also used for several off-label purposes, including treating depression, post-traumatic stress disorder (PTSD), sleep problems, and certain side effects of selective serotonin reuptake inhibitors (SSRIs).

Buspirone is not a benzodiazepine, nor is it related to barbiturates or other anxiety medications or sedatives. It is a member of the azapirones medication class, which has antidepressant and antianxiety effects. Another distinction between buspirone and Xanax is that, unlike Xanax, buspirone is not a controlled substance.

How exactly buspirone works remain largely unknown. However, research shows that buspirone activates the serotonin and dopamine receptors in the brain. Since these neurotransmitters play a significant role in regulating feelings of happiness, well-being, and mood, activating their receptors can help manage anxiety symptoms.

Buspirone usually takes a week or two to start working and up to six weeks to achieve its full clinical effect. However, your history of medication use may affect the drug’s effectiveness. Studies have shown that buspirone is less effective in treating anxiety disorders in individuals who have previously taken benzodiazepines.

As with any medication, buspirone also has the potential to cause adverse side effects, although the risk is comparatively lower. The most common side effects of buspirone include:

• Abnormal dreams
• Nausea
• Headache
• Dizziness
• Drowsiness

Rare but severe adverse effects include:

• Changes in weight or appetite
• Fainting
• Changes in blood pressure
• Muscle spasms
• Red or itchy eyes
• Slurred speech
• Confusion
• Numbness
• Blurred vision
• Chest pain or an irregular heartbeat
• Uncontrollable movements of the arms, legs, tongue, or lips
• Allergic reaction (difficulty breathing, hives, or swelling of the lips, tongue, or face)

Most of the common side effects listed above will improve over time. However, if you experience severe side effects or if the common side effects worsen over time, consult your healthcare provider immediately. Your healthcare provider will adjust your dose to help improve your symptoms.

Xanax, the brand name for alprazolam, is a prescription medication approved for the short-term treatment of generalized anxiety disorder and panic disorder with or without agoraphobia. It falls into the benzodiazepine class of drugs and is also used off-label to treat insomnia and alcohol withdrawal symptoms. Like all benzodiazepines, Xanax is a Schedule IV Controlled Substance with a high potential to cause dependence and addiction.

Xanax comes in several dosage forms and strengths, including immediate-release tablets, extended-release tablets, disintegrating tablets, and an oral concentrate. For the acute treatment of GAD, the recommended initial oral dose of Xanax is 0.25 mg to 0.5 mg, delivered three times daily. The dosage may be changed every three to four days based on the patient’s response. The maximum recommended daily dosage is 4 mg (in divided doses).

Xanax oral tablets are also available in rectangle, oval, and triangle shapes. The shape of the tablet is determined by its strength. Because Xanax is a short-acting benzodiazepine with a relatively long half-life of 11 hours, its action duration is less than other benzodiazepine drugs. One to two hours after ingesting the pill, peak blood concentrations are recorded. The extended-release tablets take roughly nine hours to reach full effect and have a longer duration of action in your body.

Benzodiazepines such as Xanax enhance the effects of gamma-aminobutyric acid (GABA), a naturally occurring brain neurotransmitter. This increases tranquility, induces relaxation, and provides short-term relief of anxiety symptoms. Although Xanax’s rapid-onset effects bring welcome respite to anxious patients, they also make the drug a prime target for abuse. The American Academy of Family Physicians (AAFP) estimates that Xanax has a high potential for abuse, particularly in “at-risk” populations.

Although Xanax is quite helpful for anxiety, it does come with a list of potential side effects.
Common side effects may include:

• Drowsiness
• Appetite changes
• Weight changes
• Dizziness
• Diarrhea
• Constipation
• Sleep difficulties/insomnia
• Cognitive impairments
• Slurred speech
• Impaired coordination
• Difficulty concentrating
• Increased sweating
• Headache
• Nausea
• Vomiting
• Upset stomach
• Swelling in hands or feet
• Muscle weakness
• Muscle spasms
• Dry mouth
• Blurred vision
• Stuffy nose
• Low libido/loss of interest in sex

The adverse effects listed above are minor and do not necessitate medical attention. However, long-term usage or excessive doses of Xanax may result in severe side effects, including an increased risk of overdose and Xanax addiction.

Severe side effects of Xanax may also include:

• Signs of an allergic reaction (swelling of face, lips, tongue, or throat)
• Feeling dizzy and faint
• Shortness of breath
• Seizure
• Hallucinations
• Increase in risk-taking behaviors
• Racing thoughts
• Increased energy with a decreased need for sleep
• Double vision
• Depression
• Suicidal thoughts and ideation
• Becoming easily agitated or aggressive

Long-term Xanax abuse may also result in liver disease and jaundice. Since this is not an exhaustive list of possible Xanax side effects, you should seek medical attention if you develop any unexpected or dangerous symptoms while using this medication.

Although both buspirone and Xanax are used for treating anxiety symptoms, they are not chemically similar; thus, the issue of equivalency does not arise. Buspirone is not related to other anti-anxiety medications, such as benzodiazepines, barbiturates, or other sedative or anxiolytic drugs.

Buspirone has a comparatively low potential for abuse and addiction as it does not cause euphoria and takes longer to generate its effects. However, people may still abuse the medication to achieve extreme sedation or reduce the severity of opioid withdrawal symptoms.
Xanax, on the other hand, is highly addictive since it can induce feelings of pleasure, and its effects are felt quickly and are short-lived. People may abuse Xanax by taking multiple pills, crushing and snorting it, injecting it, or taking it via blotter paper. Xanax is known to cause tolerance and dependence within a short period.

People with addiction or physical dependence on Xanax may experience various withdrawal symptoms when trying to quit the medication abruptly, including:

• Anxiety
• Blurred vision
• Concentration problems
• Headache
• Sweating
• Panic attacks
• Racing pulse
• Insomnia
• Depression
• Restlessness
• Irritability
• Nausea or vomiting
• Poor memory
• Muscle pains and aches
• Hand tremors
• Auditory, tactile, and visual hallucinations
• Seizures
• Delirium

Benzodiazepine withdrawal symptoms can be fatal. Hence, individuals who wish to quit Xanax should seek medical advice to taper off the drug safely.

Although buspirone has a low risk of dependence and abuse, the risk of overdose remains the same as with all other medications. A buspirone overdose occurs when someone takes too much of the substance within a short period or mixes it with other substances, such as alcohol. It is rarely fatal but, based on the dosage and whether or not the person has taken other drugs or alcohol, can cause various adverse symptoms, including:

• Nausea
• Vomiting
• Excessive sweating
• Extreme sedation
• Dizziness
• Blurred vision
• Stomach pain
• Slowed or difficulty breathing
• Miosis (excessive pupil constriction or pinpoint pupils)
  Unconsciousness

Like buspirone, Xanax can also lead to an overdose when taken in large quantities or mixed with other drugs or alcohol. A Xanax overdose can be life-threatening. Some of the symptoms include:

• Confusion
• Loss of coordination
• Slurred speech
• Slow reflexes
• Extreme drowsiness
• Hallucinations
• Seizures
• Chest pain
• Labored breathing
• Abnormal heart rhythm
• Coma

Immediate medical assistance is recommended if you or someone you know is experiencing any of these symptoms.

Both buspirone and Xanax are processed by an enzyme called cytochrome-P 450 3A4 (CYP 3A4) in your body. However, certain drugs inhibit CYP3A4 and prevent buspirone or Xanax from metabolizing, leading to a buildup of buspirone or Xanax. These include erythromycin, diltiazem, and several others. Grapefruit juice can also inhibit the metabolism of buspirone or Xanax.

On the other hand, certain drugs are CYP3A4 inducers that speed up the metabolism of buspirone or Xanax, making them ineffective. These include phenytoin, carbamazepine, rifampin, and barbiturates such as phenobarbital.

Buspirone or Xanax should not be taken with opioid painkillers, as the combination can increase the risk of sedation, respiratory depression, overdose, and even death. They should also not be taken with other CNS depressants, including alcohol, antipsychotics, antidepressants, and anticonvulsants. The combination can lead to an increased risk of serotonin syndrome, CNS depression, and psychomotor impairment. In addition, monoamine oxidase inhibitors (MAOIs) should not be used within 14 days of taking buspirone, as doing so can lead to serotonin syndrome or an increase in blood pressure.

Both buspirone and Xanax are effective treatment options for relief from anxiety symptoms and other psychiatric disorders. However, both have different chemical makeup and mechanism of action, distinguishing them from each other.