High Dose Buspirone for Tardive Dyskinesias.

 


MECHANISM OF ACTION:

  • Partial agonist at 5-HT1A.

  • Low affinity as antagonist for dopamine D2 auto-receptors.

 

According to rat models:

  • Repeated use of haloperidol —> result in increase in effectiveness of 5-HT1A receptor.

  • Medications with 5-HT1A agonist property (like buspirone) —> could attenuate haloperidol induced tardive movements.

 


WHAT DOSE OF BUSPIRONE IS EFFECTIVE FOR TARDIVE DYSKINESIAS?

ANS: UPTO 180 MG/DAY.

 

STUDY #1:

  • N= 8 patients with mild- severe tardive dyskinesia. 

  • DURATION: treated for 12 weeks.

  • BUSPIRONE DOSAGE: up to 180 mg/day.

  • STUDY DESIGN: open-label study and rater was blind to buspirone dosage.

  • SCALE: Abnormal Involuntary Movement Scale (AIMS).

  • RESULTS: pretreatment and post-treatment Abnormal Involuntary Movement Scale scores revealed a mean improvement of 4.4 (p < 0.01).

  • Improvement in neuroleptic-induced extrapyramidal side effects such as parkinsonism and akathisia was also noted.

 

STUDY #2:

  • N= 42 patients admitted to inpatient psychiatry unit in China. 

  • DURATION: 6 weeks.

  • BUSPIRONE DOSAGE: for 21 patients: the initial dosage, one capsule each day, was titrated to 6–12 capsules each day within 10 days.

  • STUDY DESIGN: randomized trial reported on buspirone and antipsychotic continuation compared with placebo and antipsychotic continuation.

  • SCALE: Abnormal Involuntary Movement Scale (AIMS).

  • RESULTS: participants reporting clinically important improvement in tardive dyskinesia symptoms after 6 weeks was significantly higher in the buspirone group than in the placebo group (low-quality evidence, one RCT,78 42 people; RR 0.53, 95% CI 0.33 to 0.84).

  • ADVERSE EVENTS: dizziness, headache, nausea & vomiting.

Note that buspirone is available as tablet in United States. We were not able to find the exact dosing strength of this buspirone capsule used in China. 

 


SOURCE:
  1. Neurology. 2013 Jul 30;81(5):463-9.
  2. Health Technol Assess. 2017 Aug;21(43):1-218.
  3. Pharmacology Biochemistry and Behavior Volume 87, Issue 1, May 2007, Pages 115-121.
  4. J Clin Psychopharmacol. 1993 Jun;13(3):204-9.
  5. Med J Chinese Civil Admin 1995;7:202–3.

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Dr. Harvinder Singh, M.D. (Admin)


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