Buspirone for ADHD
Buspirone is an anxiolytic (anti-anxiety) agent that, unlike benzodiazepines, is said to have no addictive potential. This could be due to the fact that the effect is not immediate, but requires about 14 days or longer. This suggests that the effect probably occurs via down- or upregulation of receptor systems.
Buspirone does not have a sedating effect.
Product names are Anxut, Busp, Bespar
1. Way of action of buspirone
The exact effect is unknown. It is suspected:
- No GABA receptor affinity
- Partial agonist at 5-HT1A receptors
- Antagonist at D2 receptors
2. Buspirone application
Generalized anxiety disorder (admitted).
A randomized double-blind trial showed that buspirone reduced ADHD symptoms, but buspirone was significantly inferior in effect to methylphenidate.1 Another randomized double-blind study (which, however, specified fixed drug doses) also found a better reduction in inattention with methylphenidate, with otherwise the same symptom improvements and fewer side effects with buspirone.2
Several other studies also found improvements with buspirone in ADHD3 or ADHD with co-morbid oppositional defiant behavior.4
Atomoxetine and buspirone reduced ADHD symptoms slightly better than atomoxetine alone with an effect size of 0.51 compared with 0.40.5
Buspirone could potentially help limit habituation effects with long-term methylphenidate use.678
Note: The authors mention alleged addictive dangers of methylphenidate. Such a statement has not been found in any known scientific study related to drug dosing in humans. Therefore, the statement is likely to refer at most to the effect of the very high doses used in the authors’ experiments in rats, which are significantly higher than the dosage as a drug in humans.
3. Contraindications / cross effects
Buspirone is degraded via CYP3A4.
Buspirone should not be combined with (among others):
- Serotonin reuptake inhibitors
- Serotonin agonists
- Risk: Serotonin overdose
- MAO-A inhibitors
- Risk: High blood pressure
- Drugs that are metabolized (= degraded) via cytochrome P450 3A4 (CYP3A4)
Mohammadi, Hafezi, Galeiha, Hajiaghaee, Akhondzadeh (2012): Buspirone versus methylphenidate in the treatment of children with attention- deficit/ hyperactivity disorder: randomized double-blind study. Acta Med Iran. 2012;50(11):723-8. ↥
Davari-Ashtiani, Shahrbabaki, Razjouyan, Amini, Mazhabdar (2010): Buspirone versus methylphenidate in the treatment of attention deficit hyperactivity disorder: a double-blind and randomized trial. Child Psychiatry Hum Dev. 2010 Dec;41(6):641-8. doi: 10.1007/s10578-010-0193-2. ↥
Niederhofer (2003): An open trial of buspirone in the treatment of attention-deficit disorder. Hum Psychopharmacol. 2003 Aug;18(6):489-92. ↥
Gross (1995): BUSPIRONE IN ADHD WITH ODD; Journal of the American Academy of Child & Adolescent Psychiatry, Volume 34, Issue 10, 1260 ↥
Sutherland Adler, Chen, Smith, Feltner (2012): An 8-week, randomized controlled trial of atomoxetine, atomoxetine plus buspirone, or placebo in adults with ADHD. J Clin Psychiatry. 2012 Apr;73(4):445-50. doi: 10.4088/JCP.10m06788. ↥
Alam, Najam, Khan (2015): Attenuation of methylphenidate-induced tolerance on cognition by buspirone co-administration. Pak J Pharm Sci. 2015 Sep;28(5):1601-5. ↥
Alam, Najam, Naeem (2016): Attenuation of methylphenidate-induced sensitization by co-administration of buspirone. Pak J Pharm Sci. 2016 Mar;29(2):585-90. ↥
Alam, Ikram (2018): Methylphenidate-induced hepatotoxicity in rats and its reduction by buspirone. Pak J Pharm Sci. 2018 May;31(3):741-745. ↥