Buspirone vs. Xanax (Alprazolam): Which Is Right For You?

Medically reviewed by Erika Prouty, PharmD

Buspirone and Xanax (alprazolam) are prescription medications used to treat anxiety disorders in adults.

Although both are equally effective for anxiety, buspirone, and Xanax differ in how they work in the body, their associated side effects, their potential for dependency, and more.

For example, Xanax is usually preferred for short-term use since it starts working quickly–within the first week of treatment. However, it may cause drowsiness and sedation.

On the other hand, buspirone provides gradual and continuous improvement but may cause appetite disturbances and abdominal complaints.

This article compares buspirone and Xanax. It looks at each of their uses, mechanisms of action, dosages, formulations, and how quickly and how long they work for anxiety.

Boxed Warnings

• Combining Xanax with opioids, alcohol, or other central nervous system (CNS) depressants (including street drugs) can cause severe drowsiness, excessive sleepiness, or can slow or stop your breathing.

• Xanax is a controlled substance. Misusing this medication can lead to addiction, overdose, or death. It is possible to develop an addiction even if you take medication as prescribed by your healthcare provider. Therefore, it is important to keep the medication in a secure location where others cannot access it.

• Abruptly stopping use can result in life-threatening withdrawal symptoms that may last for months. Talk to your healthcare provider about how to safely take yourself off of your Xanax regimen if needed.
  

What Are the Main Differences Between Buspirone and Xanax?

Xanax and buspirone both treat anxiety disorders in adults.

Xanax, a benzodiazepine, binds to the brain's gamma-aminobutyric acid (GABA) receptors, while buspirone binds to serotonin and dopamine receptors, although its exact method of action is not fully understood. Buspirone, which is not a benzodiazepine, does not cause significant sedation.

Xanax and buspirone are both approved to manage anxiety disorders and relieve anxiety symptoms. Xanax, however, can also treat panic disorders with or without agoraphobia.

Xanax should only be used short-term, as it addresses anxiety symptoms, not the underlying causes. For long-term use, buspirone is a more appropriate option.

Xanax (Alprazolam)

• Used to manage anxiety disorders or relieve anxiety symptoms; also treats panic disorder

• Available generically or under brand names Xanax and Xanax XR

• Comes in tablet form in strengths of 0.25 mg, 0.5 mg, 1 mg, and 2 mg

• Provides faster (within one week) symptom relief

• Higher risk of dependency

Buspirone

• Used to manage anxiety disorders or relieve anxiety symptoms

• Available generically; brand name Buspar no longer available

• Comes in tablet form in strengths of 5 mg, 7.5 mg, 10 mg, 15 mg, and 30 mg

• Provides more gradual, continuous symptom improvement

• Lower risk of dependency

Buspirone vs Xanax: Off-Label Uses

Healthcare providers may prescribe medications for conditions they are not approved to treat if there is evidence that it can be helpful. This is known as off-label use.

Xanax is occasionally prescribed off-label to treat anxiety in children.

Meanwhile, buspirone can be used off-label to treat anxiety in children or with other medicines to treat depression.

Is Buspirone or Xanax More Effective?

Studies show that buspirone and Xanax are equally effective at treating anxiety and its symptoms.

One four-week study included 60 people with generalized anxiety disorder treated with one of three medications: buspirone, alprazolam, or lorazepam. All of these medications produced similarly significant reductions in anxiety by the end of the study.

Another study that compared buspirone and Xanax for six weeks in 94 people had similar results in how effectively they reduced anxiety symptoms. However, the study noted significant differences in how quickly each worked.

Xanax provided improvement within the first week of the study, and buspirone showed a more gradual, continuous improvement throughout the study. Buspirone typically takes about two to four weeks to fully reduce anxiety symptoms.

What Are the Side Effects of Buspirone vs. Xanax?

Both Xanax and buspirone have the potential to cause side effects. However, Xanax is more likely to cause drowsiness, lethargy, and fatigue.

Buspirone, on the other hand, may be more likely to cause gastrointestinal-related side effects, such as appetite changes or stomach complaints.

Common Side Effects

The following listed side effects are more common with using Xanax and buspirone.

Xanax

• Drowsiness

• Fatigue

• Impaired coordination

• Irritability

• Impaired concentration

• Difficulty speaking

• Confusion

• Decreased sex drive (libido)

• Constipation

• Dry mouth or excessive saliva

• Rash

• Appetite changes

• Dizziness

• Insomnia (trouble sleeping)

• Headache

• Menstrual irregularities

Buspirone

• Dizziness

• Drowsiness

• Nervousness

• Insomnia

• Impaired concentration

• Hostility

• Confusion

• Nausea

• Abdominal distress

• Diarrhea

• Blurred vision

• Numbness

• Headache

• Excitement

Severe Side Effects

The following side effects of Xanax and buspirone can be severe and potentially life-threatening. Tell your healthcare provider immediately if you notice the emergence or worsening of any of these side effects.

Xanax

• Angioedema (swelling under the skin)

• Dependency or abuse

  
  

• Fast heart rate

  
  

• Liver damage

  
  

• Low blood pressure (hypotension)

  
  

• Respiratory depression (if used with other benzodiazepines or opioids)

  
  

• Seizures

  
  

• Stevens-Johnson syndrome, a rare skin disorder

  
  

• Withdrawal symptoms following abrupt discontinuation

Buspirone

• Depression
  

• Hostility

• Restlessness

• Seizures

• Uncontrolled movement

• Suicidality

• Withdrawal symptoms following abrupt discontinuation

  
  

What Is the Dosage of Buspirone vs. Xanax?

Below are the general dosing recommendations for buspirone and Xanax. However, it's best always to follow your healthcare provider's instructions on the proper dosage for you.

• Xanax for anxiety: To treat anxiety, Xanax is typically prescribed from 0.25 milligrams (mg) to 0.5 milligrams three times a day. The dosage may be gradually increased every three to four days, up to a recommended maximum daily dose of 4 milligrams. The maximum daily dose is 10 milligrams.

• Xanax for panic disorder: To treat panic disorder, extended-release Xanax may be initially prescribed at 0.5 milligrams three times a day. The dosage can be gradually increased every three to four days, but no more than 1 milligram daily. The maximum daily dose is 10 milligrams.

• Buspirone for anxiety: The initial dosing is 10 milligrams to 15 milligrams per day in two to three divided doses. The dosage can be gradually increased by 5 milligrams every two to three days if necessary. The typical dosing range is 20 to 30 milligrams daily in two to three divided doses. It is important not to exceed a maximum daily dosage of 60 milligrams.
  

Buspirone and Xanax Drug Interactions

Taking Xanax with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Avoid combining with the following:

• Opioids

• Other CNS depressants like alcohol, seizure medications, and psychotropic medications

• CYP3A inhibitors (except ritonavir), such as ketoconazole and Sporanox (itraconazole)

• CYP3A inducers, such as Luvox (fluvoxamine) and erythromycin

Ask your healthcare provider before using opioid medication, sleeping pills, muscle relaxers, or medicine for anxiety or seizures.

Tell your healthcare provider about all the medicines you’re taking. Many drugs can affect buspirone.

You should not take buspirone within 14 days of taking MAOIs, such as Nardil (phenelzine) and Parnate (tranylcypromine). Doing so can increase the risk of serotonin syndrome.

Other interactions that can occur with buspirone:

• St. John's wort

• Antibiotics, such as erythromycin and rifampin

• Antifungal drugs, such as itraconazole and ketoconazole

• Certain heart or blood pressure medications, such as Cardizem (diltiazem) and Verelan (verapamil)

• Certain seizure medications, including Tegretol (carbamazepine), Dilantin (phenytoin), and phenobarbital

• Monoamine oxidase (MAO) inhibitors, including Nardil (phenelzine) and Parnate (tranylcypromine)

• Other medications that induce or inhibit CYP3A4, such as nefazodone, Norvir (ritonavir), and dexamethasone

Also, avoid alcohol and drinking large amounts of grapefruit juice.

Who Should Not Take Buspirone vs Xanax?

Both buspirone and Xanax come with various safety warnings. Depending on certain health considerations, you may need to avoid taking either of these medications altogether.

Xanax

You should avoid taking Xanax:

• With opioids, alcohol, and other CNS depressants, this combination can cause severe drowsiness, excessive sleepiness, shallow or slowed breathing, or coma.

• During pregnancy.

• If you are taking certain medications, like strong CYP3A inhibitors (e.g., azole antifungals).

Talk to your healthcare provider about special precautions to take with Xanax if you:

• Have a history of substance misuse or dependence.

• Have a history of depression.

Buspirone

You should avoid taking buspirone:

• If you are allergic to buspirone or any of its ingredients.

• With any MAOIs.

• While pregnant or breastfeeding.
  

Summary

Buspirone and Xanax are two common medications used to manage anxiety.

Studies show that buspirone and Xanax are equally effective at treating anxiety and its symptoms. However, they differ in the time they take to work, associated side effects, and the potential for abuse.

When determining which medication is right for you, your healthcare provider may consider several factors, such as your symptoms, medical history, and current medication use.

Frequently Asked Questions

Can buspirone or Xanax be used while pregnant or breastfeeding?

It is not advisable to use Xanax during pregnancy. Additionally, breastfeeding while taking Xanax is not recommended due to the risk of adverse reactions, including sedation and withdrawal symptoms, in breastfed infants.

Buspirone should be used during pregnancy only if needed. You should not breastfeed while using buspirone.

Inform your healthcare provider if you become pregnant, are planning to become pregnant, or are breastfeeding while taking either of these medications.

Is buspirone or Xanax more expensive?

The cost of your medication depends on your insurance plan and whether you are prescribed a brand name or generic version.

Xanax, a brand-name medication, will likely cost more than generic buspirone. However, Xanax is also available generically as alprazolam.

How long does buspirone and Xanax take to work?

Xanax is fully absorbed in one to two hours. It produces rapid relief of symptoms within the first week of treatment.

Buspirone doesn't provide immediate relief. Anxiety symptoms such as restlessness may initially worsen before gradually improving over time. It typically takes around two to four weeks for this medication to reduce anxiety effectively.