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buspirone

Sold as Bucapsol, Buspar. Class: Azaspirodecanedione derivatives. First FDA approval 09/29/1986: 40 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (83/100)

Safety ×35%
A
Evidence ×25%
F
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
C

Safety: 100

Evidence: 48

Regulatory history: 93

Money & lawsuits: 100

Options: 70

What the FDA label says

Approved uses

INDICATIONS AND USAGE Buspirone hydrochloride tablets, USP are indicated for the management of anxiety disorders or the short-term relief of the symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. The efficacy of buspirone hydrochloride tablets, USP has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD). Many of the patients enrolled in these studies also had coexisting depressive symptoms and buspirone hydrochloride tablets, USP relieved anxiety in the presence of these coexisting depressive symptoms. The patients evaluated in these studies had experienced symptoms for periods of 1 month to over 1 year prior to the study, with an average symptom duration of 6 months. Generalized Anxiety Disorder (300.02) is described in the American Psychiatric Association’s Diagnostic and Statistical Manual, III 1 as follows: Generalized, persistent anxiety (of at least 1 month continual duration), manifested by symptoms from three of the four following categories: 1. Motor tension: shakiness, jitteriness, jumpiness, trembling...

Contraindications

CONTRAINDICATIONS Buspirone hydrochloride tablets, USP are contraindicated in patients hypersensitive to buspirone hydrochloride. The use of monoamine oxidase inhibitors (MAOIs) intended to treat depression with buspirone or within 14 days of stopping treatment with buspirone is contraindicated because of an increased risk of serotonin syndrome and/or elevated blood pressure. The use of buspirone within 14 days of stopping an MAOI intended to treat depression is also contraindicated. Starting buspirone in a patient who is being treated with reversible MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome. (see WARNINGS , DOSAGE AND ADMINISTRATION AND DRUG INTERACTIONS ).

Warnings and precautions

WARNINGS The administration of buspirone hydrochloride tablets, USP to a patient taking a monoamine oxidase inhibitor (MAOI) may pose a hazard. There have been reports of the occurrence of elevated blood pressure when buspirone hydrochloride, USP has been added to a regimen including an MAOI. Therefore, it is recommended that buspirone hydrochloride tablets, USP not be used concomitantly with an MAOI. Serotonin Syndrome The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs SSRIs, and other serotonergic drugs, including buspirone, alone but particularly with concomitant use of other serotonergic drugs (including triptans), with drugs that impair metabolism of serotonin (in particular, MAOIs, including reversible MAOIs such as linezolid and intravenous methylene blue), or with antipsychotics or other dopamine antagonists. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular changes (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination), sei...

Adverse reactions (label)

ADVERSE REACTIONS (See also PRECAUTIONS ) Commonly Observed The more commonly observed untoward events associated with the use of buspirone hydrochloride tablets, USP not seen at an equivalent incidence among placebo-treated patients include dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Associated with Discontinuation of Treatment One guide to the relative clinical importance of adverse events associated with buspirone hydrochloride tablets, USP is provided by the frequency with which they caused drug discontinuation during clinical testing. Approximately 10% of the 2200 anxious patients who participated in the buspirone hydrochloride tablets, USP premarketing clinical efficacy trials in anxiety disorders lasting 3 to 4 weeks discontinued treatment due to an adverse event. The more common events causing discontinuation included: central nervous system disturbances (3.4%), primarily dizziness, insomnia, nervousness, drowsiness, and lightheaded feeling; gastrointestinal disturbances (1.2%), primarily nausea; and miscellaneous disturbances (1.1%), primarily headache and fatigue. In addition, 3.4% of patients had multiple complaints, none of which could be ...

Source: FDA SPL label for Buspirone Hydrochloride (Proficient Rx LP), effective 20260101. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

33,976reports that mention this drug
33,836of those blame this drug, not another one the person was taking
56%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
7.6%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Nausea · 2,372Fatigue · 2,337Drug Ineffective · 2,311Anxiety · 2,000Headache · 1,846Diarrhoea · 1,620Pain · 1,616Off Label Use · 1,596Dizziness · 1,533Dyspnoea · 1,415Depression · 1,404Fall · 1,240Vomiting · 1,145Insomnia · 1,095Product Dose Omission Issue · 1,085

Reports per year

20192020202120222023202420252026
3,0403,1072,6822,8862,9223,1623,6061,804

1,084 reports blaming this drug for every million Medicare prescriptions filled, which is 0.4× the typical drug on this site. (8,505 reports in 2024–2026, against 7,847,445 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

10recall actions on file
2 / 22brand / generic applications
0label changes since 2021
NoREMS program
DateClassFirmReason
04/2026Class IIIUnichem Pharmaceuticals USA Inc.Subpotent drug
10/2023Class IIINCS Healthcare of Kentucky IncPresence of Foreign Tablets: Potential of stray tablet(s) of Amlodipine Besylate 10 mg Tablet within the recalled lots
10/2023Class IIINCS Healthcare of Kentucky IncPresence of Foreign Tablets: Potential of stray tablet(s) of Amlodipine Besylate 10 mg Tablet within the recalled lots
03/2023Class IINorthwind Pharmaceuticals LLCCGMP Deviations
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
02/2023Class IIAccord Healthcare, Inc.CGMP Deviations: recalling drug products following an FDA inspection.
05/2021Class IIOxford Pharmaceuticals, LLCPresence of Foreign Tablets/Capsules

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

191randomized trials (PubMed)
4systematic reviews
72registered trials
46%of completed trials posted results
15%terminated or withdrawn
17%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

1,554,487Medicare Part D patients (2024)
7,847,445prescriptions filled
$14average cost per fill
$111Mtotal Medicare spend

Same-class alternatives

No same-class alternatives found in RxClass.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are nausea, fatigue, anxiety. How would we recognize and handle those?
  2. What result are we expecting, by when, and what is the plan if it does not happen?
  3. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)