9 Buspirone Interactions You Should Know About

Anxiety disorders affect over 40 million adults in the U.S. And the numbers have continued to climb in recent years. This makes anxiety disorders some of the most common mental health conditions. Buspirone is a medication that may be prescribed to help manage symptoms.

Buspirone is a medication that’s FDA approved to treat generalized anxiety disorder (GAD, or simply “anxiety”). It belongs to a class of medications known as azapirones. While experts aren’t fully clear how it works, it’s believed to affect serotonin levels in the brain.

A specific liver enzyme (protein) breaks down buspirone. But this same enzyme also helps break down many other medications and foods. This can cause buspirone interactions. In most cases, this raises the likelihood of buspirone side effects.

Let’s take a look at nine common buspirone interactions and how to manage them. But keep in mind that this isn’t a comprehensive list. Your healthcare provider and pharmacist can more thoroughly check your medication list for interactions.

1. Monoamine oxidase inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are antidepressants prescribed to treat depression and Parkinson’s disease. They tend to have many side effects, as well as medication and food interactions.

MAOIs and buspirone both affect serotonin levels in the brain. But taking them together raises the risk for developing serotonin syndrome. This is a potentially life-threatening condition caused by too much serotonin. Symptoms include a fast heart rate, sweating, and uncontrollable body movements. Taking these medications together can also raise your blood pressure.

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You should not take a MAOI and buspirone together. If you’re switching from one to the other, your healthcare provider will ask you to stop your old medication and wait 2 weeks before starting the new one. This allows your body to fully clear one medication before the other is introduced.

2. Other antidepressants

Many antidepressants work by raising serotonin levels in the brain. Similar to MAOIs, combining buspirone with other antidepressants raises the risk of serotonin syndrome. But the risk is much lower than it is with MAOIs.

Common antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft)

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta)

• Tricyclic antidepressants (TCAs) like amitriptyline

Your healthcare provider may think you could benefit from both buspirone and an antidepressant. In this case, they’ll likely monitor you closely for symptoms of serotonin syndrome. If you notice stiff muscles, a fever, or a fast heart rate, seek medical care right away.

3. Triptan migraine medications

Triptans are popular prescription medications prescribed to treat migraines. They work by attaching to serotonin receptors (binding sites) in the brain. Because they affect serotonin, there’s a risk of serotonin syndrome when taken with buspirone. Because triptans aren’t typically taken every day, the risk is low.

It’s likely your healthcare provider will give you the OK to use triptans despite this interaction. Just make sure they know you also take buspirone. They’ll likely ask you to watch for symptoms of serotonin syndrome after taking your triptan. If you do experience any symptoms, contact them or get medical help.

4. Diltiazem

Diltiazem (Cardizem) is a calcium channel blocker. It’s prescribed to treat chest pain caused by poor blood flow to the heart. The extended-release version (Cardizem CD) can also treat high blood pressure. Diltiazem slows down the enzyme that breaks down buspirone. This means it can lead to too much buspirone in your body. This raises your risk of side effects, such as dizziness, drowsiness, or nausea.

Some people may need to take both of these medications. This buspirone interaction can often be managed with dosage changes. Your healthcare provider may lower your dose of buspirone to help prevent side effects.

5. Verapamil

Verapamil is another calcium channel blocker. It can treat high blood pressure, chest pain, and certain types of abnormal heartbeats. Similar to diltiazem, verapamil slows the enzyme that breaks down buspirone. This can lead to too much buspirone in the body and raise your risk of side effects.

This interaction may not require you to stop a medication. But your healthcare provider may lower your buspirone dosage to avoid side effects. Let them know if you’re experiencing new or worse side effects if you take both verapamil and buspirone.

6. Erythromycin

Erythromycin (Ery-Tab) is a macrolide antibiotic used to treat certain bacterial infections. It can also slow down the enzyme that breaks down buspirone. This means buspirone levels may go up while taking both. And your risk of side effects also goes up.

If erythromycin is an option for treating your infection, your healthcare provider will decide if the benefit outweighs the risk of side effects. They may prefer to prescribe a different antibiotic if an alternative is available.

7. Grapefruit juice

Grapefruit juice is well known for its tendency to interact with many medications. And buspirone is one such medication. Similar to the interactions above, grapefruit slows down the enzyme that breaks down buspirone. This makes it last longer in the body and can lead to a buildup of buspirone. This raises your risk of side effects.

Grapefruit and grapefruit juice can interact with buspirone even if you don’t take them at the same time. But this interaction seems to be most problematic when people eat or drink large quantities of grapefruit products. So you may not need to cut out grapefruit completely. It’s best to ask your healthcare provider about a safe amount of grapefruit products you can have.

8. Nefazodone

Nefazodone is an antidepressant used to treat depression. It slows down the enzyme that breaks down buspirone. Studies have found nefazodone leads to a significant increase in buspirone levels. Taking these two medications together increases your risk of side effects, such as dizziness, lightheadedness, and drowsiness.

Many people with depression also have anxiety. If your healthcare provider decides you could benefit from taking both medications, it’s recommended to take a very low dosage (2.5 mg once daily) of buspirone. But your provider may prefer to change one of your medications to help avoid this interaction. There are other antidepressants that can be safely combined with buspirone.

9. Paxlovid and other medications that contain ritonavir

Paxlovid (nirmatrelvir/ritonavir) is an oral medication authorized to treat mild to moderate COVID-19. It contains two antiviral medications: nirmatrelvir and ritonavir. Ritonavir is also found in certain HIV medications, such as Kaletra (lopinavir/ritonavir).

As with most of the medications already discussed, ritonavir slows down the enzyme that breaks down buspirone. This can lead to too much buspirone in the body. This raises your chances of side effects, especially drowsiness.

If you need to take Paxlovid, your healthcare provider may decide to temporarily lower your buspirone dose. If you take ritonavir daily, it’s likely they’ve prescribed a low buspirone dosage. Your provider may ask you to keep an eye out for excessive tiredness with this combination.

When should I contact my healthcare provider about a buspirone interaction?

Before starting buspirone, give your healthcare provider and pharmacist an updated medication list. Include all prescription and over-the-counter medications. And always update your healthcare team when any changes are made. Make sure to also mention if you drink grapefruit juice. Keeping your healthcare team up to date can help prevent unwanted or excessive side effects and potential buspirone interactions.

Contact your healthcare provider if you develop any new or worsening buspirone side effects. These can indicate a potential interaction, especially if you recently changed another medication. They can monitor you for a potential interaction and change your dose of buspirone if needed. But don’t attempt to stop or change your buspirone dosage on your own.

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Written by:

Kristine Foley, PharmD

Kristine Foley is a licensed pharmacist with over 13 years of community pharmacy experience. She earned her Doctor of Pharmacy degree from Rutgers University.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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