Buspirone vs. Xanax for Anxiety: The Top 6 Differences to Keep in Mind
Key takeaways:
Buspirone and Xanax (alprazolam) are two common antianxiety medications. They treat anxiety in different ways.
Xanax can treat short-term anxiety and panic attacks; it isn’t intended for long-term use. Buspirone might be a better option for long-term anxiety treatment.
Xanax can cause dependence and misuse. Buspirone doesn’t carry the same risks. Your healthcare professional should consider your symptoms, your medical history, and the potential risks when considering if one of these medications might be right for you.
Table of contents
Anxiety can disrupt your daily life with symptoms like worry, fear, or nervousness. So if you're experiencing anxiety, it's helpful to know what treatment options are at your disposal.
Medication is often an important way to manage anxiety symptoms. Below, we’ll compare six key differences between two common antianxiety medications: buspirone versus Xanax (alprazolam).
1. Buspirone and Xanax aren’t part of the same medication class
Xanax is part of a class of medications called benzodiazepines, commonly known as “benzos.” Some other common medications in this family are lorazepam (Ativan) and clonazepam (Klonopin).
Are you experiencing anxiety? Read about the most common anxiety medications and how they work to lessen symptoms.
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What to expect: Read what GoodRx Health pharmacists have to say about starting a new anxiety medication.
Xanax is FDA approved to treat generalized anxiety disorder (anxiety) and panic disorder in adults. But it’s only meant to be used as a short-term treatment — meaning, up to 10 weeks for panic disorder and up to 4 months for anxiety. Taking Xanax long term can raise the risk of dependence, which we’ll discuss more below.
Buspirone is the only medication in its class. It's approved to treat anxiety, but it’s not necessarily a first-choice treatment option. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are usually tried first. But your healthcare professional may want to add buspirone to your treatment plan if your anxiety isn’t well managed with an SSRI or SNRI alone.
2. Buspirone and Xanax work in different ways
Xanax works by attaching to gamma-aminobutyric acid (GABA) receptors (binding sites) in the brain. GABA is a chemical that slows down communication between nerves, promoting feelings of calm. When Xanax binds to GABA receptors, it helps GABA attach more easily. This amplifies GABA’s calming effects.
By contrast, research suggests that buspirone affects serotonin levels in the brain. It does this by attaching to serotonin receptors. Low serotonin levels have been linked to anxiety.
3. Xanax is a controlled substance, but buspirone isn’t
Controlled substances are medications that can cause physical or mental dependence or misuse. Xanax is a Schedule 4 controlled substance.
All benzodiazepines, including Xanax, can cause dependence. This means your body might rely on Xanax to feel normal or at ease. Dependence can happen even if you take Xanax exactly as your prescriber tells you to. That’s one reason it’s recommended to take the medication for the shortest amount of time possible.
Dependence can also lead to Xanax misuse. Signs of misuse include taking Xanax more often or at higher dosages than prescribed. Misusing Xanax can increase the risk of a benzodiazepine overdose.
If you think you’re exhibiting signs of dependence or misuse while taking Xanax, contact your prescriber. They can advise you on how to proceed.
On the other hand, buspirone is not a controlled substance. So it may be a safer option than Xanax for some people. This is especially true for people who have a history of substance use disorder.
4. They’re taken differently
Xanax typically starts to work within 30 minutes to 1 hour of taking a dose. But its effects don’t last long. This is why Xanax is usually taken several times a day.
A typical starting Xanax dosage for anxiety is 0.25 mg to 0.5 mg by mouth 3 times a day. For panic attacks, 0.5 mg by mouth 3 times a day is typical. Xanax is available as immediate-release tablets, orally disintegrating tablets, and an oral solution. It’s also available as extended-release tablets.
Xanax is typically used to relieve short-term anxiety symptoms. In some cases, people may be prescribed Xanax on a temporary basis while they wait to feel the effects of other antianxiety medications. A healthcare professional may also recommend only taking Xanax as needed, rather than on a scheduled basis.
Prescribers usually recommend starting buspirone at a low dosage to allow the body to adjust to the medication. A typical starting buspirone dosage is 7.5 mg by mouth twice daily. Depending on how you respond to the medication, and whether you experience side effects, your prescriber may raise your dosage over time. Buspirone is available in tablets ranging from 5 mg to 30 mg.
Buspirone is mostly used to treat chronic (long-term) anxiety. It doesn’t provide quick relief of anxiety symptoms. In fact, it takes about 2 to 4 weeks to feel the medication’s full effects. You should keep taking buspirone as prescribed even if you don’t feel its effects right away.
5. Buspirone tends to have less side effects
No medication is risk-free. Buspirone may cause side effects such as headaches, nausea, and nervousness. Xanax’s side effects can include fatigue, poor coordination, and memory lapses. As mentioned, Xanax can also lead to dependence, misuse, and overdose.
Buspirone usually causes fewer side effects than benzodiazepines, including Xanax. Buspirone is less likely to make you feel sleepy, dizzy, or confused during the day.
6. Buspirone and Xanax have different drug interactions
Buspirone and Xanax work differently in the body, which means that they also have different drug interactions.
These are some key medications and substances that can interact with buspirone:
Monoamine oxidase inhibitors (MAOIs): Combining buspirone with an MAOI, such as phenelzine, can dangerously raise serotonin levels. This could result in serotonin syndrome. You shouldn’t take an MAOI and buspirone at the same time.
SSRIs and SNRIs: Buspirone may interact with other antidepressants, namely SSRIs and SNRIs. Combining buspirone with one of these medications could raise the risk of experiencing serotonin syndrome.
Diltiazem and verapamil: The heart medications diltiazem and verapamil can slow the activity of liver enzymes (proteins) that break down buspirone. This raises the risk of experiencing buspirone side effects. If you’re taking one of these heart medications, your healthcare professional may adjust your buspirone dosage to minimize the risk of side effects.
Grapefruit juice: Grapefruit products can also slow the activity of proteins that break down buspirone. This, again, raises the risk of side effects. Ask your healthcare professional about a safe amount of grapefruit to consume while taking buspirone.
The following medications and substances can interact with Xanax:
Opioids: Xanax is a central nervous system (CNS) depressant, which means it has a calming effect on the brain and body. Opioid medications have similar effects. When Xanax is taken with opioids, these side effects can be additive. Your healthcare professional will likely only prescribe these medications together if other alternatives have failed to work.
Other medications that cause drowsiness: In addition to opioids, other CNS depressants that can cause excessive sedation can interact with Xanax. This includes barbiturates like phenobarbital, sleep medications like zolpidem (Ambien), and other benzodiazepines. Medications that cause drowsiness as a side effect, such as diphenhydramine (Benadryl) and trazodone, are also a concern.
Carbamazepine (Tegretol, Equetro): Carbamazepine can lower Xanax levels in the body by speeding up activity of the protein that breaks Xanax down. This may make Xanax less effective. Your healthcare professional may need to increase your Xanax dosage if you take these medications together.
Alcohol: Alcohol has similar calming effects to Xanax. Consuming Xanax and alcohol together can cause confusion, trouble balancing, and shallower breathing. It can also raise your risk of having a Xanax overdose. Talk to your healthcare professional if you consume alcohol on a regular basis.
These are not comprehensive lists of the substances and medications that can interact with buspirone and Xanax. Be sure to let your prescriber and pharmacist know about all of the medications you take before starting treatment with one of these medications. This includes any prescription medications, over-the-counter products, or dietary supplements.
The bottom line
Buspirone and Xanax (alprazolam) are two common antianxiety medications. They aren’t first-choice medications for anxiety, but they’re each helpful in certain situations. Xanax can offer short-term relief from anxiety and panic attacks, while buspirone might be a better option for long-term anxiety relief. If anxiety is affecting your daily life, contact a healthcare professional. They can work with you to determine if one of these antianxiety medications is right for you.
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References
Canadian Agency for Drugs and Technologies in Health. (2012). Buspirone for the treatment of anxiety: A review of clinical effectiveness, safety, and cost-effectiveness.
Locke, A. B., et al. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American Family Physician.
Quality Care Products. (2024). Busiprone HCL - buspirone hydrochloride tablet [package insert]. DailyMed.
RPK Pharmaceuticals. (2024). Alprazolam tablet [package insert]. DailyMed.
U.S. Drug Enforcement Administration. (n.d.). Drug scheduling.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
