If you are experiencing anxiety symptoms, you are certainly not alone—40 million Americans, or 18% of the population, have anxiety. Buspirone (also known by the brand name of BuSpar) and Xanax (alprazolam) are two FDA-approved anti-anxiety drugs that are popular treatment options for generalized anxiety disorder. Although buspirone and Xanax are both anxiolytics (drugs used in the treatment of anxiety), they have notable differences, which we will outline below.
What are the main differences between buspirone and Xanax?
Buspirone is an anti-anxiety medication and is not related to Xanax chemically. Xanax is known as a benzodiazepine. Buspirone is no longer available in its brand-name form of BuSpar—it is only available in generic. Xanax is available in both brand and generic. Buspirone is available in tablet form, while Xanax is available in an immediate-release and extended-release tablet as well as an oral concentrate.
Buspirone (Buspirone coupons | Buspirone details) is in a drug category, or class, of its own, and not related to any other medications used for anxiety. The way buspirone works is not completely understood. We do know that it is different from benzodiazepines like Xanax. Studies have shown that buspirone works on serotonin and dopamine receptors.
Xanax (Xanax coupons | Xanax details) is part of a large class of medications known as benzodiazepines. Benzodiazepines work by increasing activity at receptors for a neurotransmitter called gamma-aminobutyric acid (GABA). This all takes place in the CNS (central nervous system). Benzodiazepines produce a relaxing, calming effect and can even help promote sleep when taken at bedtime. Xanax is a controlled substance and is classified as a Schedule IV drug.
| Main differences between buspirone vs Xanax | ||
|---|---|---|
| Buspirone | Xanax | |
| Drug class | Anti-anxiety medication | Benzodiazepine |
| Brand/generic status | Generic | Brand and generic |
| What is the generic name? What is the brand name? | Brand: BuSpar (no longer available as brand) | Generic: alprazolam |
| What form(s) does the drug come in? | Tablet | Tablet (immediate-release) Extended-release tablet Oral concentrate |
| What is the standard dosage? | Initial: 7.5 mg twice daily but may slowly increase if needed Average dose is a total of 20 to 30 mg daily in divided doses (example: 15 mg twice daily for a total daily dose of 30 mg) | Usual range: 0.25 mg to 0.5 mg taken 3 times daily; dosage varies |
| How long is the typical treatment? | Short-term or long-term; consult a doctor | Short-term; some patients use longer under doctor supervision |
| Who typically uses the medication? | Adults Children 6 years and older (off-label) | Adults Children 7 years and older (off-label) |
Conditions treated by buspirone and Xanax
Buspirone and Xanax are most commonly used in the management of anxiety disorders and can help in the short-term relief of symptoms of anxiety, whether or not anxiety is associated with depressive symptoms. Xanax is also used to treat panic disorder, or panic attacks, with or without agoraphobia (fear of crowded places, or fear of leaving the home). Both drugs also are used off-label for a variety of conditions, outlined below.
| Condition | Buspirone | Xanax |
| Management of anxiety disorders | Yes | Yes |
| Short-term relief of the symptoms of anxiety | Yes | Yes |
| Short-term relief of anxiety associated with depressive symptoms | Yes | Yes |
| Treatment of panic disorder, with or without agoraphobia | Off-label | Yes |
| Rapid tranquilization of the agitated patient | No | Off-label |
| Alcohol withdrawal delirium/alcohol withdrawal syndrome | Off-label | Off-label |
| Insomnia | No | Off-label |
| Bruxism (teeth grinding) | Off-label | Off-label |
| Chemotherapy-associated anticipatory nausea and vomiting | No | Off-label |
| Delirium | No | Off-label |
| Depression | Off-label | Off-label |
| Essential tremor | No | Off-label |
| Tardive dyskinesia (repetitive, involuntary movements, often caused by long-term use of antipsychotic medications) | Off-label | Off-label |
| Post-traumatic stress disorder | Off-label | Off-label |
| Tinnitus (ringing in the ears) | No | Off-label |
| Premenstrual syndrome | Off-label | Off-label |
Is buspirone or Xanax more effective?
In a study comparing buspirone and Xanax, both drugs were found to be equally effective in treating symptoms of anxiety, and buspirone was found to have less side effects and fewer withdrawal symptoms than Xanax.
Another study looked at buspirone and Xanax, as well as Valium (diazepam), and the effect on daytime sleepiness. The study found buspirone to cause the least drowsiness of the three drugs. By day 7, the differences between the drugs in terms of daytime sleepiness was not significant, but the patients who took alprazolam or diazepam had slower reaction times on a visual reaction timed-performance test. The authors concluded that although the drugs are similarly effective, buspirone may be better in patients where daytime alertness is critical.
The most effective medication for you should only be determined by your doctor, who can look at your medical condition(s) and history, as well as other medications you take.
Common side effects of buspirone vs Xanax
The most common adverse effects of buspirone are dizziness, headache, and weakness. Patients may also experience nausea, nervousness, lightheadedness, and/or excitement.
The most common side effects of Xanax are sedation, dizziness, and weakness. Other side effects that may occur include lightheadedness, memory problems, confusion, dry mouth, disorientation, euphoria, seizures, vertigo, vision changes, slurred speech, sexual problems, headache, coma, respiratory depression (slowed breathing, not getting enough oxygen), and/or GI (gastrointestinal) symptoms such as upset stomach, nausea, constipation, or diarrhea.
Other side effects may occur. Consult your healthcare professional for a full list of side effects.
| Buspirone | Xanax | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Sedation | Yes | 4% (same as placebo) | Yes | 41-77% |
| Headache | Yes | 6% | Yes | 12.9% (but less than placebo) |
| Dizziness | Yes | 12% | Yes | 1.8-30% |
| Weakness | Yes | 2% | Yes | 6-7% |
Source: DailyMed (buspirone), DailyMed (Xanax)
Drug interactions of buspirone and Xanax
MAOIs (monoamine oxidase inhibitors) should not be used within 14 days of buspirone, because the combination could cause serotonin syndrome or increased blood pressure.
Buspirone and Xanax are both processed, or metabolized, by an enzyme called cytochrome-P 450 3A4 (CYP 3A4). Certain drugs inhibit CYP3A4, preventing buspirone or Xanax from being metabolized, and leading to a buildup of buspirone or Xanax (and more side effects). These include diltiazem, erythromycin, and several others. It is important to note that grapefruit juice can inhibit the metabolism of buspirone or Xanax.
On the other hand, certain drugs are CYP3A4 inducers and speed up the metabolism of buspirone or Xanax (and as a result, buspirone or Xanax would not be as effective). These drugs include carbamazepine, phenytoin, rifampin, and barbiturates such as phenobarbital.
Buspirone or Xanax should not be taken with opioid painkillers, due to increased risk of sedation, respiratory depression, and overdose, possibly even leading to death. If no other combination of medicine is possible, the patient should receive both drugs at the lowest possible dose and for the shortest duration of time, and be closely monitored.
Buspirone or Xanax also should not be taken with other CNS depressants, including alcohol, antipsychotics, antidepressants (including SSRIs like Prozac), sedating antihistamines, and anticonvulsants. Depending on the combination, there could be an increased risk for serotonin syndrome, CNS depression (slowing of brain activity), and psychomotor impairment (slowed reaction, for example, when driving).
Other drug interactions may occur. Consult your healthcare provider for medical advice.
| Drug | Drug Class | Buspirone | Xanax |
| Phenelzine Rasagiline Selegiline Tranylcypromine | MAO inhibitors | Yes | No |
| Diltiazem Erythromycin Itraconazole Ketoconazole Nefazodone Ritonavir Verapamil Grapefruit juice | CYP3A4 inhibitors | Yes | Yes |
| Carbamazepine Phenobarbital Phenytoin Rifampin | CYP3A4 inducers | Yes | Yes |
| Codeine Fentanyl Oxycodone Morphine Tramadol | Opioids | Yes | Yes |
| Alcohol | Alcohol | Yes | Yes |
| Amitriptyline Citalopram Desipramine Desvenlafaxine Duloxetine Escitalopram Fluoxetine Fluvoxamine Imipramine | Antidepressants | Yes | Yes |
| Baclofen Carisoprodol Cyclobenzaprine Metaxalone | Muscle relaxants | Yes | Yes |
| Divalproex sodium Gabapentin Lamotrigine Levetiracetam Pregabalin Topiramate | Anticonvulsants | Yes | Yes |
| Diphenhydramine | Sedating antihistamines | Yes | Yes |
| Lo Loestrin Fe, etc | Oral contraceptives | No | Yes |
Warnings of buspirone vs Xanax
Buspirone
- Buspirone should not be taken within 14 days of a monoamine oxidase inhibitor (MAOI) such as phenelzine, tranylcypromine, rasagiline, or selegiline. The combination can lead to a dangerous increase in blood pressure, or a condition called serotonin syndrome. Serotonin syndrome is a life-threatening condition that can occur when serotonin levels are too high. When it happens, it is usually because of a drug or combination of drugs (such as antidepressants) that has raised the serotonin levels too much. Serotonin syndrome can be mild (tremors, diarrhea) to severe (fever and seizures) and can lead to death if untreated.
- Do not drive or operate machinery until you know how buspirone affects you.
- Patients with liver or kidney problems should not use buspirone.
- Buspirone has been studied in pregnant animals and showed no harm to the fetus, but there are no adequate studies in pregnant women. Therefore, buspirone should only be used in pregnancy if clearly needed and if approved by your OB/GYN.
Xanax
- Xanax comes with a boxed warning, the strongest warning required by the FDA. Xanax (or any benzodiazepine) should not be taken with opioid painkillers because of the risk of extreme sedation, severe respiratory depression, coma, and/or death. If the combination of a benzodiazepine and opioid cannot be avoided, the patient should be prescribed the lowest dose for the shortest period of time and be closely monitored. Patients should not drive or operate machinery until the effects of the medication are known.
- Xanax may cause physical and psychological dependence—the risk increases with higher doses, longer duration of use, or a history of drug/alcohol abuse. Because patients with panic disorder often use higher doses of Xanax, there may be a higher risk of dependence.
- If you take Xanax, take only as prescribed. Do not take additional doses.
- When discontinuing Xanax, ask your doctor for a plan to taper the medication slowly. This will help you avoid withdrawal symptoms, which may include: seizures, agitation, confusion, rapid heartbeat, vertigo, and other symptoms. Patients with seizure disorders are at higher risk for withdrawal symptoms.
- There is a risk of suicide in patients with depression. Patients with depression should be treated with an antidepressant and should be closely monitored.
- Xanax should be used with caution in patients with lung problems such as COPD or sleep apnea.
- Talk to your doctor about adjusting the dose of Xanax if you have liver problems.
- Xanax is on the Beers’ List (drugs that may be inappropriate for use in older adults). Because older adults have increased sensitivity to benzodiazepines, there is an increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes when Xanax is used.
- Xanax should not be used in pregnancy, because it can cause harm to the fetus. If you are already taking buspirone or Xanax and find out that you are pregnant, contact your OB/GYN immediately.
Frequently asked questions about buspirone vs Xanax
What is buspirone?
Buspirone is a drug used for anxiety. It is available in generic form and is usually covered by insurance.
What is Xanax?
Xanax is part of the benzodiazepine category of drugs. It is used for anxiety and panic disorder. It is available in both brand and generic, and as an immediate-release or extended-release tablet. Xanax is usually covered by insurance in the generic form of alprazolam but may be covered at a higher copay in the brand-name form.
Other benzodiazepines you may have heard of include Ativan (lorazepam), Klonopin (clonazepam), and Valium (diazepam). Because Xanax is a controlled substance with the potential for abuse, it is advisable to store it out of the reach of children, preferably locked up, if possible.
Are buspirone and Xanax the same?
While they both treat anxiety, they work differently. The way buspirone works is not quite understood but involves serotonin and dopamine. Xanax (and other drugs in the benzodiazepine class) works on GABA receptors in the brain.
Is buspirone or Xanax better?
In clinical studies, both drugs were shown to be equally effective for anxiety. However, buspirone may cause less daytime drowsiness.
That being said, both drugs are very popular. Because everyone is different, it is best to check with your doctor and he/she can review your current symptoms and medical history as well as other medications you take, to determine if buspirone or Xanax is better for you.
Can I use buspirone or Xanax while pregnant?
Buspirone is a pregnancy category B. Studies in animals showed no harm to the fetus, but there are no adequate studies in pregnant women. Therefore, buspirone should only be used in pregnancy if the benefits outweigh the risks, and under the supervision of your OB/GYN.
Xanax is a pregnancy category D. Taking the drug while pregnant can cause harm to the baby, and should not be used. If you are already taking buspirone or Xanax and find out that you are pregnant, contact your OB/GYN immediately.
Can I use buspirone or Xanax with alcohol?
No. The combination of buspirone or Xanax with alcohol can be very dangerous or even deadly. Together, alcohol plus buspirone or Xanax can lead to CNS depression (slowed brain activity), respiratory depression (slowed breathing and not getting enough oxygen), and even lead to coma and/or death.
How does buspirone make you feel?
After a week or so, when buspirone starts to kick in, you will start to feel less anxious. You may also experience some side effects, such as dizziness, headache, or weakness. If your dose needs to be increased, your doctor will slowly increase the dose so side effects are minimized. If any side effects are particularly bothersome, check in with your healthcare provider.
How long does it take for buspirone to kick in?
Buspirone does not start working immediately. It can take one or two weeks to begin working, and you may not feel the full effect until four to six weeks.
Can buspirone replace Xanax?
Maybe. Buspirone and Xanax work differently, but they both treat anxiety. Patients taking buspirone tend to experience less sedation. Ask your doctor if one of these drugs is right for you.
Does buspirone help you sleep?
Buspirone is not reported to cause sedation. However, if your anxiety is better in general because you are taking buspirone, you may sleep better as a result of feeling less anxious. In clinical studies, 10% of patients experienced drowsiness, but 9% of patients taking a placebo (an inactive pill) also reported feeling drowsy. Also, 3% of patients reported insomnia, but 3% of patients taking placebo also experienced insomnia.
