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
• 2. Buspirone application
• 3. Contraindications / cross effects

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)