Buspirone vs Xanax: Differences and Side Effects

With more than 40 million American adults suffering from some form of anxiety disorder, it is no surprise that anxiety medications are among the most commonly prescribed medications in the United States. 

Buspirone (sold under the brand name Buspar) and Xanax (sold under the generic name alprazolam) are two effective anti-anxiety medications that are primarily used for the management of anxiety symptoms in adults. 

If your doctor is treating you with buspirone vs Xanax, or alprazolam, you’ll want to familiarize yourself with the differences between these medications.

Drug Class

Buspirone and Xanax belong to two different drug classes. 

Buspirone is an anxiolytic drug that works differently from other medications used to manage anxiety symptoms.

Buspirone is available in the form of a tablet.

By contrast, Xanax belongs to a class of drugs called benzodiazepines.

Benzodiazepines like Xanax work by increasing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps reduce feelings of anxiety.

Xanax can be purchased as an immediate-release or extended-release tablet, and it is also available in the form of an oral concentrate.

Conditions Treated

The conditions treated by Buspirone and Xanax differ slightly. Xanax is approved by the U.S. Food and Drug Administration (FDA) for the treatment of anxiety disorders, short-term relief of anxiety symptoms, anxiety associated with depression, and panic disorder characterized by recurrent panic attacks.

Buspirone is FDA-approved for the management of anxiety disorders, short-term relief of anxiety symptoms, and short-term relief of anxiety that is experienced in conjunction with depressive symptoms. 

Anxiety

Everyone experiences anxiety occasionally, as stress is a normal part of everyday life. However, some people may have persistent feelings of anxiety that can evolve into an anxiety disorder over time. 

People are diagnosed with an anxiety disorder when their feelings of anxiety last longer than six months, are extreme, or interfere with daily activities and quality of life. There are different types of anxiety disorders, including:

• Generalized anxiety disorder
• Panic disorder
• Post-traumatic stress disorder.
• Social anxiety disorder
• Obsessive-compulsive disorder
• Separation anxiety disorder
• Agoraphobia
• Specific phobia

Symptoms of anxiety include: 

• Restlessness 
• Difficulty concentrating
• Insomnia
• Increased heart rate 
• Rapid breathing 

Xanax can be used to treat anxiety attacks, which are sudden episodes of anxiety. Symptoms of anxiety attacks include: 

• Feeling faint or dizzy 
• Apprehension and worry 
• Restlessness
• Numbness or tingling
• Shortness of breath 
• Distress 
• Fear 
• Dry mouth
• Sweating 
• Chills or hot flashes

 Side Effects

Side effects for both Xanax and Buspirone can be categorized as common, less common, and serious.  Common side effects of Xanax include:

• Memory impairment
• Blurred vision
• Ataxia
• Skin rash
• Weight gain
• Weight loss
• Increased appetite
• Decreased appetite
• Dysarthria
• Fatigue
• Difficulty in micturition
• Drowsiness
• Insomnia 
• Decreased libido
• Cognitive dysfunction
• Diarrhea
• Anxiety 
• Constipation

Common side effects of Buspirone include: 

• Dizziness
• Weakness
• Nausea
• Headache
• Nervousness
• Lightheadedness
• Excitement
• Confusion
• Insomnia
• Rash
• Fatigue
• Blurred vision
• Dry mouth
• Diarrhea
• Constipation
• Vomiting
• Numbness
• Incoordination

Less common side effects of Xanax include:

• Increased libido
• Sexual disorder
• Hypotension
• Muscle twitching
• Less common side effects of Buspirone include:
• Muscle spasms
• Slurred speech
• Psychosis
• Joint pain

Serious side effects of Xanax are associated with depression of the central nervous system. Serious side effects associated with Xanax include:

• Slowed breathing
• Respiratory failure
• Suicidal thoughts
• Psychological and physical dependence
• Serious allergic reaction (antihistamines may be needed)

Serious side effects of Buspirone are rare but can occur in some patients. These side effects include:

• Shakiness or tremors
• Mask-like facial expression
• Tardive dyskinesia (stiff, jerky movements of the face and body that cannot be controlled)
• Muscle stiffness
• Jerky walking movements
• Unusual or uncontrolled movements of the face

Drug Interactions

There are two major differences between the two medications in terms of their drug interactions. Buspirone interacts with MAO inhibitors such as phenelzine, rasagiline, selegiline, and tranylcypromine, while Xanax does not.

Xanax is known to interact with oral contraceptives such as Lo Loestrin Fe, while buspirone does not.

For the most part, the drug interactions for buspirone and Xanax are very similar because the medications are processed in the same way. 

Both medications are processed by an enzyme in the body known as CYP3A4. Some medications are known to prevent the action of CYP3A4, and when combined with buspirone or Xanax, these drugs can cause the levels of buspirone or Xanax to build up in the body to potentially dangerous levels.

As a result, buspirone and Xanax should not be combined with CYP3A4-inhibiting drugs such as diltiazem and erythromycin, among others. Grapefruit and grapefruit juice can also inhibit the action of CYP3A4 and should not be consumed while using buspirone or Xanax.

Other medications increase the action of CYP3A4, which means that buspirone and Xanax would be processed more quickly and would thus be less effective. Examples of CYP3A4 inducers include carbamazepine, rifampin, phenytoin, and phenobarbital.

Buspirone and Xanax both act as central nervous system depressants and should not be taken with other similar medications and substances that have a sedative effect on the body, including antipsychotics, muscle relaxers, antihistamines, antidepressants, anticonvulsants, and alcohol. 

Opioid painkillers are particularly dangerous when used with buspirone or Xanax because they contribute to an increased risk of sedation, respiratory depression, and overdose, which can be fatal. 

Effectiveness

Buspirone and Xanax are used slightly differently for the treatment of anxiety, but both medications have been found to be equally effective in helping people manage their anxiety symptoms.

Compared to Xanax, buspirone is associated with fewer side effects and fewer withdrawal symptoms. 

Patients who need to be alert during the day but who need to take medication to manage their anxiety may prefer to take buspirone to treat their anxiety.

However, a doctor or healthcare provider will choose the right medication based on medical history, the condition being treated, and other factors. 

Warnings

Buspirone and Xanax both come with warnings for use, but they are quite different in nature. 

Buspirone
Buspirone should not be taken within two weeks of an MAOI, as the combination can cause a life-threatening increase in blood pressure or serotonin syndrome, which can be a medical emergency. 

Serotonin syndrome is a dangerous medical condition that occurs when levels of serotonin in the brain increase to abnormally high levels.

Symptoms range from more mild effects, like diarrhea and tremors, to serious effects, such as fever, seizures, or death. 

Additionally, people with liver or kidney problems should not use buspirone, and pregnant women should consult their healthcare provider before using the medication.

Xanax
Xanax has several serious warnings associated with its use. Xanax may cause extreme sedation, severe respiratory depression, coma, or death when combined with opioid painkillers.

People with lung problems should also use Xanax with caution, as they may be more likely to experience severe respiratory depression.

The drug is also associated with a high likelihood of physical or psychological dependence, particularly when taken at high doses or for longer than prescribed.

People with a history or addiction to drugs or alcohol are considered to be at an increased risk of dependence or addiction.

People who become dependent on Xanax may be more likely to experience withdrawal symptoms when abruptly stopping or reducing their dosage.

Withdrawal symptoms associated with the medication include seizures, rapid heartbeat, agitation, dizziness, confusion, and other symptoms.

Older adults are more likely to be sensitive to benzodiazepines like Xanax, which puts them at increased risk for experiencing side effects.

Some side effects, such as cognitive impairment, falls, delirium, fractures, and increased risk of motor vehicle crashes, can be serious.

Xanax carries a high risk of harm to unborn babies when taken by pregnant women. Therefore, Xanax should be avoided during pregnancy.

Summary

Buspirone is generally associated with fewer side effects than Xanax and has a much lower potential for abuse.

The medications are both effective treatments for anxiety depending on a patient’s individual needs. Patients can save on generic buspirone and alprazolam as well as brand-name Xanax with a pharmacy discount card from Pharmacists.org.

References, Studies and Sources
https://www.webmd.com/drugs/2/drug-9824/xanax-oral/details 
https://pubmed.ncbi.nlm.nih.gov/3146770/ 
https://www.webmd.com/drugs/2/drug-8876/buspirone-oral/details 
https://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorder 
https://link.springer.com/article/10.1007/BF03259411