Think of BUSPirone as 2nd option for managing anxiety

Don't think of buspirone as similar to a benzodiazepines. Buspirone doesn't provide quick symptom relief, muscle relaxation, etc....

As a clinical pharmacist, you will be asked more about medications for managing anxiety and RECENT spot shortages of buspirone will raise questions about its role in treating anxiety, since it's unrelated to other anxiety medications.

Don't think of buspirone as similar to a benzodiazepines. Buspirone doesn't provide quick symptom relief, muscle relaxation, etc. But it also doesn't have the abuse, dependence, or withdrawal concerns of benzos. Plus buspirone seems less effective in patients who've used a benzo long-term. And neither buspirone nor a benzo is first-line for anxiety.

Expect to see most patients taking an SSRI or SNRI. These have better evidence than buspirone for generalized or social anxiety disorder. If starting an SSRI or SNRI, minimize initial agitation by starting with a low dose, such as sertraline (Lustral) 25 mg/day or venlafaxine ER 37.5 mg/day, and titrate up. Allow 2 to 4 weeks to start to see some benefit. Continue SSRIs or SNRIs for patients taking them at home. Abruptly stopping can lead to withdrawal, flu-like symptoms, hyperarousal, etc. Think of buspirone if an SSRI or SNRI isn't tolerated or as an add-on if they aren't enough. In these cases, start with 7.5 mg BID and titrate every few days. Advise that it usually takes about 2 weeks to start seeing some effect. Don't be surprised to see buspirone doses up to 60 mg/day on home medication lists. But ensure doses are divided BID or TID and not used PRN.

Feel comfortable holding buspirone on admission if it's unavailable, stopping it doesn't cause withdrawal. Continue to save benzos for severe anxiety disorders or limited use, such as for just a few weeks until an SSRI or SNRI kicks in. Consider hydroxyzine if a quick-onset medication is needed to avoid a benzo. But hydroxyzine has limited evidence, anticholinergic effects, and QT prolongation concerns. At discharge, recommend cognitive behavioral therapy if practical.

References

Slee A, Nazareth I, Bondaronek P, Liu Y, Cheng Z, Freemantle N. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet. 2019 Feb 23;393(10173):768-777.
Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opin Pharmacother. 2018 Jul;19(10):1057-1070.
Abejuela HR, Osser DN. The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Algorithm for Generalized Anxiety Disorder. Harv Rev Psychiatry. 2016 Jul-Aug;24(4):243-56.