Praxis Medical Insights

Est. 2024 • Clinical Guidelines Distilled

Made possible by volunteer editors from the University of Calgary & University of Alberta

Last Updated: 9/19/2025

Buspirone Tapering Protocol

  • A gradual taper of buspirone 20mg BID should follow a reduction of 10% of the original dose per week, which is approximately 5mg per week, divided across both daily doses, as recommended by the Centers for Disease Control and Prevention, based on MMWR Recommendations and Reports 1, 2
  • The American College of Physicians, as reported in Mayo Clinic Proceedings, suggests reducing the dose by 2.5mg BID in the first week, and continue with weekly reductions of 2.5mg BID until reaching 10mg BID 2, 1
  • At lower doses (10mg BID and below), the Centers for Disease Control and Prevention recommends slowing the taper further to 1-2mg reductions per week, based on MMWR Recommendations and Reports 1

Rationale for This Approach

  • The 10% reduction per week approach is consistent with general tapering guidelines for centrally acting medications, as stated by the Centers for Disease Control and Prevention, based on MMWR Recommendations and Reports, and the American College of Physicians, as reported in Mayo Clinic Proceedings 3, 2

Monitoring During Tapering

  • The Centers for Disease Control and Prevention recommends assessing for withdrawal symptoms after each dose reduction before proceeding to the next step, based on MMWR Recommendations and Reports 1
  • Common withdrawal symptoms to monitor include anxiety, insomnia, irritability, and potential return of original anxiety symptoms, according to the American College of Physicians, as reported in Mayo Clinic Proceedings 2
  • If withdrawal symptoms occur, the Centers for Disease Control and Prevention suggests returning to the previous well-tolerated dose and slowing the taper further, based on MMWR Recommendations and Reports 1

Special Considerations

  • For patients who have been taking buspirone for longer durations (≥1 year), the Centers for Disease Control and Prevention recommends considering a slower taper of 10% per month rather than per week, based on MMWR Recommendations and Reports 1
  • The American College of Physicians, as reported in Mayo Clinic Proceedings, suggests considering adjunctive treatments to manage any emerging anxiety symptoms during the taper 2

Potential Pitfalls to Avoid

  • The American College of Physicians, as reported in Mayo Clinic Proceedings, warns against abrupt discontinuation, which increases risk of withdrawal symptoms and anxiety rebound 2
  • The Centers for Disease Control and Prevention advises against using a fixed tapering schedule for all patients, and recommends being prepared to adjust based on individual response, based on MMWR Recommendations and Reports 1

Follow-up Recommendations

  • The Centers for Disease Control and Prevention recommends scheduling follow-up appointments at each dose reduction stage to assess tolerance, based on MMWR Recommendations and Reports 1
  • If anxiety symptoms re-emerge during tapering, the Centers for Disease Control and Prevention suggests considering pausing the taper at the current dose before continuing, based on MMWR Recommendations and Reports 1
  • The Centers for Disease Control and Prevention advises documenting the patient's response to guide future treatment decisions if needed, based on MMWR Recommendations and Reports 1

REFERENCES

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