Buspirone Nursing Implications
Buspirone Nursing Pharmacology
Buspirone is a drug prescribed for the short-term treatment of generalized anxiety disorder and suppresses anxiety-related symptoms, including dizziness, tension, fear, and irritability. It is also given as the second line of treatment for depression. Buspirone is not indicated to treat psychotic disorders.
Indications of Buspirone
- Generalized anxiety disorder. Buspirone is highly effective in people who suffer mild to moderate generalized anxiety. If a patient does not respond to or cannot withstand the side effects of serotonin reuptake inhibitors (SSRIs), it is commonly used as a second-line drug next to SSRIs
- Depression. Buspirone may also help patients with a generalized anxiety disorder improve their depression symptoms.
Mechanism of Action of Buspirone
Buspirone belongs to the drug class called azapirones, which is the alternative group for benzodiazepines prescribed for anxiety. It has a good absorption capacity for serotonin 5HT1a receptors, acting as a specific receptor, which some experts believe is responsible for the majority of the known clinical effects.
Buspirone also has a low solubility for serotonin 5HT2 receptors and is a limited antagonist for dopamine D2 autoreceptors. The benzodiazepine GABA receptors remain unaffected. The exact mechanism behind how the partial 5HT1a agonism corresponds to clinical results remains to be determined.
Elevated serotonergic activity in the amygdala and other parts of the brain’s anxiety/fear circuitry is suggested. Buspirone’s clinically observed late anxiolytic effects suggest that it brings relief via 5HT1a receptor adaptations.
Pharmacokinetics of Buspirone
Buspirone’s peak and area under the plasma concentration-time curve (AUC) were elevated twofold when given with food. Peak and AUC increased 2-fold after a single 20 mg dose in patients with impaired renal function compared to healthy volunteers.
The Peak and AUC for the same dose were 15-fold higher in patients with impaired liver functions compared to healthy individuals.The drug is rapidly absorbed after an oral dose of buspirone.
Peak. The average peak plasma concentration is about 2.5 micrograms/L, and the period to reach the peak is less than 1 hour. Buspirone’s peak and area under the plasma concentration-time curve (AUC) were elevated twofold when given with food. Peak and AUC increased 2-fold after a single 20 mg dose in patients with impaired renal function compared to healthy volunteers. The Peak and AUC for the same dose were 15-fold higher in patients with impaired liver functions compared to healthy individuals.
Metabolism. Buspirone is metabolized in the liver and is eliminated by the kidneys. Buspirone’s release profile is approximately 4%. Buspirone is extremely metabolized. 1-pyrimidinylpiperazine (1-PP) is a major metabolite of buspirone that may influence its pharmacological activity. Buspirone has an amount of distribution of 5.3 L/kg, systemic clearance of approximately 1.7 L/h/kg, an elimination half-life of approximately 2.5 hours, and pharmacokinetics that are linear over a dose range of 10 to 40 mg. There was no collection of either parent compound or metabolite after 9 days of multiple-dose administration of buspirone 10 mg/day.
Halflife. Buspirone’s half-life was twice that of healthy people in patients with hepatic impairment.
Buspirone’s pharmacokinetics are unaffected by age or gender. Coadministration of buspirone with certain antibiotics, antidepressants, MAOIs, and anticoagulants substantially enhanced buspirone plasma concentrations, whereas antacids and other anxiolytics, and anti-panic medications had no effect.
Side Effects of Buspirone
Side effects of buspirone are possible. Notify the doctor if any of the following symptoms are serious or consistent:
- Feeling of excitement
- Difficulty sleeping or staying asleep
- Feelings of anger
- Increased perspiration
Several of the side effects of buspirone can be severe. If the patient experience any of the following symptoms, refer to the doctor right away:
- Chest pain
- Shortness of breath
- Blurred vision
- Increased or irregular heartbeat
- Shaking of a part of the body that is uncontrollable
- Extreme excitement
- Swelling of the face, eyes, mouth, throat, tongue, or lips.
- Stiffness or twitching of muscles
- Loss of coordination
Although a severe allergic reaction to this medication is unusual, refer to the doctor if one occurs. A severe allergic reaction may cause the following:
- Itching/swelling (especially of the face/tongue/throat)
- Severe dizziness
- Difficulty breathing.
If any of the following overdose symptoms occur, seek immediate medical attention:
- Dizziness mostly when getting up from a sitting or lying position.
- Severe drowsiness
- Loss of consciousness
- Upset stomach
- Pinpoint pupils of the eyes
Adverse Effects of Buspirone
- Central Nervous System: CNS depression, akathisia, serotonin syndrome, confusion, dizziness, drowsiness, headache, numbness, paraesthesia, excitement.
- Special senses: Blurring vision, tinnitus
- Cardiovascular: Chest pain
- Respiratory: nasal stuffiness
- Dermatologic: Excessive sweating, rashes
- Gastrointestinal: Throat pain, diarrhea, nausea
- Neuromuscular and skeletal: muscle weakness, joint pain, muscle pain, tremor
- Hepatic: Some incidents of elevated serum liver enzyme without jaundice.
Drug Interactions with Buspirone
- Anticoagulants. Buspirone may enhance the effect of anticoagulants when taken together, increasing the risk of bleeding.
- MAOIs. When combined with MAOIs, buspirone may cause a serious increase in blood pressure.
- Antibiotics. Giving certain antibiotics with buspirone can lead to a rise in buspirone levels in the body. When combined with buspirone with these antibiotics, This raises the chances of side effects including high blood pressure. If the patient is taking both of these medicines, the doctor may adjust the dose.
- Antidepressants. Taking certain antidepressant medications with buspirone can raise buspirone levels in the body. This raises the chances of side effects, including serotonin syndrome. This condition can cause stiff muscles, a high fever, sweating, nausea, and vomiting. Additionally, taking these medications together may result in liver enzyme abnormalities. If the patient is taking one of these drugs, the doctor may change the dosage of buspirone.
- Antifungals.– Taking buspirone with some of these drugs used to treat fungal infections can raise the buspirone levels. This raises the chances of side effects. If the patient is taking buspirone with one of these medications, the doctor may adjust the dose.
- Anti-seizures. Certain seizure medications, when combined with buspirone, can reduce the level of buspirone in the body. This could end up making buspirone less effective, and it may not treat the anxiety as well. If the patient is taking buspirone with one of these medications, the doctor may adjust the dose.
- Antihypertensives. Certain blood pressure medications can raise buspirone levels in the body. This raises the chances of side effects. If the patient is taking buspirone with one of these medications, the doctor may adjust the dose.
- HIV drugs. Some such HIV-treatment drugs can raise buspirone levels in the body. This raises the chances of side effects.. If the patient is taking buspirone with one of these medications, the doctor may adjust the dose.
- Corticosteroids. It is used to treat conditions such as immune disorders, as well as skin, eye, and respiratory issues. Certain corticosteroids when combined with buspirone, can reduce the level of buspirone in the body. It can end up making buspirone less effective, and it may not treat the anxiety as well. If the patient is taking buspirone with dexamethasone, their doctor may adjust the dose.
Nursing Considerations for Patient son Buspirone
- Conduct a detailed physical examination before beginning drug therapy to define baseline information, determine therapy effectiveness, and assess the incidence of any adverse effects related to drug therapy Assess patient comprehension of drug therapy by asking the patient to mention the drug, its indication, and potential side effects. To avoid potentially serious adverse reactions, check for a history of seizure disorders, psychiatric problems, suicidal thoughts within the last 24 hours or within the next 48 hours.
- Check the patient’s blood pressure (BP) and compare it to the normal values. Refer to the attending physician changes in blood pressure, either an unusual decrease in blood pressure (hypotension) or a consistent increase in blood pressure (hypertension). Examine the patient’s heart rate, ECG, and heart sounds, particularly during exercise. Monitor for tachycardia or other arrhythmia symptoms such as increased heart rate, chest tightness, difficulty breathing, syncope, and extreme tiredness. Refer to the doctor accordingly. Observe the patient for any breathing issues and report any symptoms of pulmonary congestion, such as shortness of breath, rapid shallow breathing, or abnormal breath sounds.
- Keep an eye out for any changes in the patient’s personality, such as excitement or nervousness. Inform the doctor if these changes get worsen. Examine dizziness and drowsiness, which may impair walking, balance, and other functional activities. Inform the physician of any balance issues or limited mobility, and advise the patient and family/caregivers about fall prevention to avoid falls and trauma.
- Protect the patient from falls and injuries (hip fractures, head injury, and so forth). Maintain fall-prevention techniques, particularly in older adults or if drowsiness and dizziness persist during the day. To prevent injuries, provide safety measures such as adequate lighting and raised side rails. Use caution during aerobic exercise and other forms of therapeutic exercise due to the risk of arrhythmias and abnormal BP responses. Evaluate the patient’s exercise tolerance on a regular basis (BP, heart rate, fatigue levels), and stop exercise immediately if any unfavorable responses occur.
- Assist the patient in considering nonpharmacologic solutions of anxiety reduction, including relaxation techniques, exercise, counseling, support groups, etc.
- Review the patient’s adherence to drug therapy. To increase compliance, have a series of discussions with the patient to educate them on drug therapy.
- If the patient has certain medical conditions, they should not take this medication without doctor’s advice. Instruct the patient to consult the physician first before using this medication if they have kidney or liver problems.
- Tell the patient to consult a doctor before taking buspirone if they are allergic to it or if they have any other allergies. Inactive ingredients in this product may trigger allergic reactions or other problems.
- Instruct patients to inform their doctor prior to taking buspirone if they have past alcohol or drug abuse.
- Before using buspirone, instruct the patient to inform the doctor about their medical history, especially if they have bipolar disorder (manic-depression) or Parkinson’s disease.
- Buspirone may cause dizziness or drowsiness. The patient may become dizzy or drowsy if they consume alcohol or marijuana (cannabis). Advise the patient not to drive, operate machinery, or do anything else that requires alertness until they are sure they can do it safely. Avoid alcoholic beverages as much as possible while on this treatment. If the patient uses marijuana, tell them to consult with their doctor first.
- Buspirone may intensify the effects of alcohol and other CNS depressants (medicines that cause drowsiness or decrease alertness). Antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, are examples of CNS depressants. Tell the patient to notify their doctor before doing any of the following while taking this medication.
- If the patient is taking other anxiety medications, tell them not to stop them suddenly unless directed by their doctor. Buspirone will not relieve withdrawal symptoms from other medications, and their dose may need to be gradually reduced when switching to buspirone. Encourage the patient to discuss their treatment plan with their doctor. Inform the patient that if they experience withdrawal symptoms, visit their doctor as soon as possible.
- During pregnancy, buspirone should be used only when absolutely necessary. Before using this medication, advise the patient to inform their doctor if they are pregnant. Consult with the doctor first about the risks and benefits.
- Before using this medication, instruct the patient to inform their doctor of all prescription and nonprescription/herbal products they may be using. Certain drugs can slow or speed up the removal of buspirone from the body by affecting specific liver enzymes.
- Check the labels on all of the patient’s medications (such as allergy or cough-and-cold products) because they may contain drowsy ingredients. Instruct the patient to consult with their doctor about how to use those products safely.
- Buspirone may cause false test results in some medical/laboratory tests (including a brain scan for Parkinson’s disease). Instruct the patient to notify their doctors that they are taking buspirone prior to having any diagnostic procedures. The patient may need to discontinue the medication for at least 48 hours prior to the test.
- Keep an eye out for symptoms of buspirone overdose, such as nausea, vomiting, dizziness, drowsiness, miosis, and gastric distress. In the event of an overdose, monitor the patient’s respiration, pulse, and blood pressure. Call the emergency hotline if the patient experiences serious symptoms such as passing out or difficulty breathing. Otherwise, contact a poison control center immediately.
- If the patient forgets to take a dose, instruct them to do so as soon as they remember. If the next dose is approaching, skip the missed dose. Take the next dose at the usual time. To catch up, do not double the dose.
- If the patient has been taking buspirone for a long period of time, inform them that the doctor should monitor their progress at regular visits to ensure the medication is working properly and not causing unwanted side effects.
- It is important that the patient hold a written record of all prescription and nonprescription (over-the-counter) medications they are taking, as well as any vitamins, minerals, or other dietary supplements. Advise the patient to bring this list with them whenever they go to the doctor or are admitted to the hospital. It is also essential to have it on hand in case of an emergency.
- Remind the patient to keep all of their scheduled medical and laboratory appointments. If they are also taking another antidepressant, liver function tests may be performed on a regular basis to monitor for side effects. For more information, they should speak with their doctor.
- Keep track of laboratory tests (e.g., renal and liver function tests, complete blood count (CBC), etc.) to ensure that the therapy is effective and that developing complications are treated as soon as possible.
- Instruct the patient not to keep buspirone in his or her bathroom. Keep all medications out of the reach of children and pets.
- Tell the patient not to flush medications or pour them down the drain unless instructed to do so. When this product has expired or is no longer needed, properly dispose of it. More information on how to safely dispose of this product can be obtained from their pharmacist or a local waste disposal company.
- Instruct the patient not to give their medication to anyone else. Tell them to speak with their pharmacist if they have any questions about refilling the prescription.
- If the patient requires surgery, including dental surgery, instruct the patient to inform the doctor or dentist about taking buspirone.
- Instruct the patient to keep this medication in the original container, tightly closed, at room temperature, and away from light, excessive heat, and moisture (not in the bathroom).
- After starting treatment, offer the patient frequent follow-ups to evaluate for therapeutic and adverse effects. Encourage patients to stick to their medication schedule and whether they take it before or after meals. It usually takes 2 to 4 weeks for the therapeutic efficacy to kick in. Many of the adverse effects will often disappear over time. Keep a close eye on the patient for any signs of anaphylaxis, akathisia, or serotonin syndrome.
- Teach the patient to take the buspirone exactly as prescribed. All directions on the prescription label must be followed. Their doctor may occasionally adjust the dose to ensure the best results for the patient. Advise the patient not to take this medication in larger or smaller amounts or for a longer period of time than prescribed.
- Inform the patient that grapefruit products should be avoided. Grapefruit raises the drug’s plasma concentrations.
Nursing Diagnosis for Patients on Buspirone
Possible Nursing Diagnosis for Buspirone
- Diarrhea related to the possible side effect of buspirone
- Acute Pain (Headache) related to the possible side effect of buspirone
- Nausea related to the possible side effect of buspirone
- Disturbed Sleep related to the possible side effect of buspirone
- Risk for Disturbed Sensory Perception related to the possible side effect of buspirone
- Risk for Anaphylactic Reaction related to drug allergy to buspirone
|Buspirone Nursing Interventions||Rationale|
|Assess the patient for signs and symptoms of anxiety.||To confirm the indication for administering buspirone.|
|Assess if the patient has benzodiazepine dependence.||Buspirone is generally contraindicated in patients with benzodiazepine dependence as it belongs to the drug class called azapirones which are the alternatives for benzodiazepines and have similar potent effect.|
|Check the patient’s allergy status.||Previous allergic reactions to buspirone or other azapirones may render the patient unable to take them. Alternatives to buspirone should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||It is possible to prescribe buspirone to pregnant women as this drug is under pregnancy category B which means it does not impose known harm to humans. However, extreme caution is needed as buspirone must only be administered under the direction of the physician. Buspirone also crosses the placenta as well as may be present in breast milk.|
|Perform a focused neurological assessment of the patient.||Buspirone may cause adverse CNS effects such as blurry vision and lightheadedness.|
|Assess the patient’s oral cavity in preparation for administering buspirone.||To ensure that the patient is able to tolerate the oral medication before buspirone is given.|
Nursing Planning and Intervention
|Buspirone Nursing Interventions||Rationale|
|Administer buspirone orally. This oral route should be considered if the patient has no swallowing problems and as indicated by the physician.||To ensure optimal absorption and therapeutic action by buspirone, as well as reduce possible side effects.|
|Monitor for the expected effects and side effects of the drug. Ask the patient to report any feeling of euphoria.||To check for the benefits and side effects of buspirone. The patient should not feel “high” or euphoric. This should be reported to the prescribing physician if the patient verbalizes it.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking buspirone.||To inform the patient on the basics of buspirone.|
|Discourage alcohol intake when on buspirone.||Alcohol can increase the possible nervous system and GI side effects of buspirone, such as drowsiness, nausea and vomiting.|
|Inform the patient that buspirone may cause nausea and vomiting and this should be reported to any healthcare professional once noticed.||To inform the patient of the possible side effect of buspirone on the gastrointestinal system, and to be able to administer antiemetics as soon as the patient reports the symptom.|
|Buspirone Nursing Interventions||Rationale|
|Ask the patient to repeat the information about buspirone.||To evaluate the effectiveness of health teaching on buspirone.|
|Check for any signs of allergic reaction to buspirone, such as shortness of breath, skin rash, or swelling.||To ensure the patient’s safety after the initial dose of buspirone and to be able to reverse anaphylaxis quickly.|
|Monitor the patient’s anxiety levels.||To evaluate the effectiveness of buspirone.|
|Monitor the patient’s level of consciousness and mentation.||Buspirone may cause alterations in sensory perceptions and cognition.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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