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Anxiety Medications

Buspirone vs. Xanax (Alprazolam): Differences and Similarities

Written by:

Jessica Guht

MEng

Reviewer:

Dr. Michael Chichak

Updated: 09.06.2024

The medications listed on this website are provided for informational purposes only.

Their inclusion does not guarantee they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. Healthcare providers may prescribe other medications or recommend non-pharmacological treatment based on the patient’s unique health circumstances and needs. Read more

Boxed warning: Xanax (alprazolam)

Xanax has a boxed warning [1*] , the most serious type of warning from the Food and Drug Administration (FDA). Xanax’s active ingredient alprazolam has a risk of abuse, misuse, and addiction; concomitant use of Xanax and opioids can be life-threatening. Xanax is also a controlled substance, indicating its high potential for misuse or dependence. Specific federal and state laws limit the amount of this medication that can be prescribed or dispensed within a certain period of time.

Highlights

Buspirone and Xanax are both prescribed to adults to treat anxiety, but Xanax can also treat panic disorder.
Xanax begins working faster while it takes longer to see the full effects of buspirone. However, Xanax is only recommended for short-term use, while buspirone can be used longer-term.
Both Xanax and buspirone can cause withdrawal if abruptly stopped, so you must work with your healthcare provider to safely discontinue any of these medications.
Both medications are generally covered by insurance.

Buspirone and Xanax are two medications prescribed to manage generalized anxiety disorder. However, despite their shared goal, they accomplish it by different means—this equates to varying mechanisms of action, side effects, and drug interactions.

This guide compiles the key similarities and differences between these two prescription medications so that you can better compare how buspirone is similar to Xanax.

Discuss treatment options for anxiety with a medical professional without having to leave your house.

What Are Buspirone and Xanax Used to Treat?

Buspirone is the same as Xanax in that both are used to treat generalized anxiety disorder. However, the time that it takes for them to start working differs: Xanax can begin working within 30 minutes [2*] of taking the first dose, while buspirone offers gradual improvements. Along these lines, buspirone, compared to Xanax, is preferred for long-term use.

Xanax has more applications, though; in addition to managing anxiety disorders and symptoms, it can also treat panic disorder with and without agoraphobia.

There are also off-label uses for both Xanax and buspirone. Xanax may be prescribed off-label to treat anxiety in children [3*] , while buspirone may also be used off-label to treat depression [4*] .

Condition	Buspirone	Xanax
Generalized Anxiety Disorder (GAD)	✅	✅
Panic Disorder	❌	✅
Major Depressive Disorder (MDD)	Off-label	Off-label
Insomnia	❌	Off-label
Premenstrual Dysphoric Disorder (PMDD)	❌	Off-label

Comparing Buspirone vs Xanax: Key Differences

While both medications are equally effective [5*] in treating anxiety, they have key differences in how they work in the body. Buspirone binds to serotonin and dopamine receptors, while Xanax (alprazolam) is a benzodiazepine that binds to the brain’s gamma-aminobutyric acid (GABA) receptors. These mechanisms of action then influence their side effects, dependency risk, and dosages.

Typical Dosages and Available Forms

Xanax [6*] is available in a generic form—alprazolam—or under its brand names, Xanax and Xanax XR. It comes as a tablet, and the typical dosage of Xanax for anxiety is between 0.25 mg and 0.5 mg three times a day. For panic disorder, Xanax may initially be prescribed at 0.5 mg three times a day.

Buspirone [7*] is only available generically; its brand name Buspar [8*] is no longer offered. It is available as a tablet, and to treat anxiety, the initial dosing of buspirone is often 10-15 mg per day in two to three divided doses.

For both medications, the above values are only general dosing recommendations; a healthcare professional will prescribe you the dosage based on an individual assessment and make adjustments as needed.

Schedule an online consultation with a healthcare provider to receive a personalized treatment plan.

Side Effects Overview

While both medications can cause side effects, Xanax is more likely [9*] to trigger lethargy, drowsiness, and fatigue. In comparison, buspirone’s most common side effects relate to your gastrointestinal system, such as stomach upset or appetite changes.

The common side effects of alprazolam versus buspirone include:

Xanax	Buspirone
Drowsiness Dizziness Insomnia Impaired coordination Headache Fatigue Irritability Confusion Difficulty speaking Constipation Decreased libido Excessive saliva or dry mouth Appetite changes Rash Menstrual irregularities	Drowsiness Dizziness Insomnia Impaired concentration Headache Nervousness Nausea Diarrhea Abdominal distress Numbness Blurred vision

Some side effects of buspirone and Xanax may be severe and life-threatening. If you notice any of the following side effects develop, tell your healthcare provider immediately.

Xanax	Buspirone
Seizures Liver damage Rapid heart rate Dependence or abuse Angioedema Respiratory depression Stevens-Johnson syndrome	Seizures Hostility Depression Restlessness Suicidality Uncontrolled movement

Both medications may also cause withdrawal symptoms if you abruptly discontinue them.

Warnings and Precautions

Xanax is a controlled substance [10*] , and misusing the medication can lead to addiction, overdose, or death. Additionally, abruptly stopping Xanax can result in life-threatening withdrawal symptoms. If you would like to discontinue Xanax, you must discuss how to do it safely with your healthcare provider.

Those with a history of substance abuse or a history of depression should talk to their healthcare provider about precautions to take while on Xanax.

Those who are pregnant or breastfeeding should avoid both medications.

“With Xanax's ability to work very quickly in reducing anxiety, it is easy to develop dependency and a need for more of the medication to achieve the desired effect. This is where a medication like buspirone can come in. Buspirone is often a better choice for patients who have longer-term anxiety because it helps control anxiety symptoms without causing dependency issues. ”

Dr. Michael Chichak, MD

Medical provider at MEDvidi

Book an appointment with our healthcare provider today to have a complete treatment plan catered to your unique situation.

Food and Drug Interactions

If taken with other medications that slow your breathing or make you sleepy, Xanax can cause severe side effects or death. Avoid taking the following with Xanax:

Opioids
CYP3A inhibitors (excluding ritonavir)
CYP3A inducers
Other CNS depressants, such as seizure medication, alcohol, and psychotropic medications

Those who take Xanax should check with their doctor before taking muscle relaxers, sleeping pills, or seizure medications.

As for buspirone, taking it within two weeks of monoamine oxidase inhibitors (MAOIs) can increase your risk of serotonin syndrome, so this is not recommended.

Buspirone also holds interactions with:

Certain antibiotics
St. John’s wort
Certain seizure medications
Antifungal medications
Certain blood pressure or heart medications
Medications that inhibit or induce CYP3A4

Insurance Coverage and Cost Comparison

Both medications are typically covered by insurance and Medicare Part D, but the amount of your copay will vary based on your insurance plan. However, brand name Xanax may not be covered by insurance, and it is much more expensive than the generic version of Xanax—$246 to generic’s $92.

Buspirone generally retails around $35 for out-of-pocket payments; with insurance, the cost may be lower.

Key Pros and Cons

Gathered in the table below is a list comparing the features of Xanax and buspirone:

	Buspirone	Xanax
Uses	Generalized anxiety disorder	Generalized anxiety disorder and panic disorder
Dependency Risk	Lower risk of dependency	Higher risk of dependency
Quickness of Relief	Gradual, continuous symptom improvement that is ideal for long-term use	Faster symptom relief that is ideal for short-term usage
Common Side Effects	Gastrointestinal issues	Lethargy, drowsiness, and fatigue
Brand name/Generic	Generic only	Brand name (Xanax) and generic available.
Cost	$35	$92 – $246

Choosing Between Buspirone and Xanax

Buspirone is equal to Xanax in how effective they are in treating anxiety, so choosing between the two will depend on the specific features of each medication. Based on your other prescriptions, medical history, or necessity for a long-term solution, your healthcare provider may decide that one medication is a better choice over the other.

Switching From Xanax to Buspirone

It is crucial to take care when switching from Xanax to buspirone. This is because quitting Xanax abruptly after a long period of use may cause withdrawal—in severe cases, someone may even develop seizures or die.

Generally, when switching from Xanax to buspirone, your healthcare provider will have you gradually taper off the medication instead of stopping abruptly.

“If you are on Xanax, or another benzodiazepine, talk to your healthcare provider before making changes to your medication regimen. Navigating these issues can be tricky and it's very important to make changes under their guidance.”

Dr. Michael Chichak, MD

Medical provider at MEDvidi

How to Get a Prescription

Since Xanax is a controlled substance, you must receive a prescription to buy and use it legally. Buspirone is not a controlled substance but still requires a prescription from a licensed healthcare practitioner.

At MEDvidi, the process includes the following steps:

Sign up and book a video appointment with a healthcare provider.
Go through a symptom assessment. Based on a review of your health status, a healthcare provider will determine whether you need a prescription for Xanax, Buspirone, or another medication or need non-pharmacological treatment.
If you get prescribed medication, your prescription will be sent digitally to a pharmacy of your choice.

For both medications, follow-up appointments are crucial to monitor your response to the medication and make adjustments as necessary. With MEDvidi, though, you can attend your follow-up appointments online from home.

Note that if you are taking Suboxone, you must provide MEDvidi with a reference letter from your clinician indicating that it is safe and appropriate for you to be prescribed Xanax. Taking Xanax and Suboxone at the same time causes dangerous interactions.

See a medical professional to evaluate your anxiety symptoms and discuss treatment options.

Note that booking an appointment doesn’t guarantee obtaining a prescription. The decision is at the discretion of your healthcare provider.

Summing Up

Both buspirone and Xanax can be used to manage anxiety. However, Xanax is used for short-term help with acute symptoms. Buspirone, compared to Xanax, can be prescribed for long-term treatment. Both medications require a prescription from a healthcare professional, which is provided only if it’s deemed the most appropriate method of treatment.

Get started in your anxiety management process today by seeing a healthcare provider with MEDvidi for an assessment.

Sources

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10 sources

ALPRAZOLAM tablet
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Alprazolam
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Buspirone
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Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study
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Xanax
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Buspirone
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Buspar
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Alprazolam versus buspirone in the treatment of outpatients with generalized anxiety disorder
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XANAX - alprazolam tablet
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