Medically reviewed
Anxiety disorder impacts more than 18% of the adult population in the United States and is the most common form of mental illness in the country. The good news is that anxiety is quite manageable today thanks to treatment options such as prescribed anxiety medications.
In this article, we’ll look at the two main FDA-approved anti-anxiety drugs: buspirone (BuSpar) and Xanax (alprazolam).
We will explore the main differences between the two, their side effects, and what conditions they can treat so that you can make a more informed decision with the help of your medical practitioner.
Main Differences
Buspirone and Xanax are anti-anxiety medications.
Each contains a unique chemical makeup, which causes certain differences between the two.
| Buspirone | Xanax | |
| Status | Available as generic | Available as brand-name and generic |
| Drug classification | Anxiolytic, anti-anxiety medication | Benzodiazepine, alprazolam anti-anxiety medication |
| Dosage | 5milligrams (mg), two times a day to start. Maximum daily usage is 60mg, however, your healthcare practitioner will adjust this to your needs. Can be consumed alongside or separately from food. Can be given to children only when prescribed by a healthcare practitioner in certain situations. | 0.25-0.5mg, 2-3 times a day to start. Might be increased to 5mg if required. Maximum daily usage is 10mg, however, your healthcare practitioner will adjust this to your needs. Can be consumed alongside or separately from food. Can be given to children only when prescribed by a healthcare practitioner in certain situations. |
| Storage | Keep out of children’s reach. Do not store or use past the expiration date. Store at room temperature, away from moisture, heat, and direct strong light. Do not freeze. | Keep out of children’s reach. Do not store or use past the expiration date. Store at room temperature, away from moisture, heat, and direct strong light. Do not freeze. |
| Form | Oral tablet | Tablet (immediate-release)Extended-release tabletOral concentrate |
| Treatment duration | It can take up to two weeks for the effects of this drug to be noticed. Your healthcare provider will monitor the results and adjust the duration of your treatment accordingly. It is prescribed for short-term as well as long-term treatment. | Effects can be felt within an hour of consumption. It is prescribed for short-term use in a majority of cases. Long-term usage is advisable only in rare cases under a medical professional’s supervision. |
Conditions Treated
Both Buspirone and Xanax are prescribed to treat anxiety disorders and related conditions.
From panic attacks to depression, your clinician can best advise which drug is most effective to treat your condition.
They can also be used off-label as detailed below.
| Buspirone | Xanax | |
| Anxiety disorders | Yes | Yes |
| Delirium | Yes | Yes |
| Dementia | Yes | Not known or ineffective |
| Insomnia | No | Off-label use |
| Chemotherapy symptoms | No | Off-label use |
| Fatigue | No | As a side effect |
| Post-traumatic stress disorder | Off-label use | Off-label use |
| Premenstrual syndrome | Off-label use | Off-label use |
| Migraines | Yes | Yes |
| Panic attacks | Yes, in mild cases | Yes |
| Alcohol withdrawal syndrome | Off-label use | Off-label use |
| Depression | Yes, for short-term use | Yes, for short-term use |
Dependence
Xanax carries the risk of dependence, while buspirone does not.
The FDA label specifically outlines these risks in the section titled, “Dependence and Withdrawal Reactions, Including Seizures.”
The label outlines that dependance on Xanax could potentially lead to certain adverse effects, some of them could be dangerous to your life.
This includes withdrawal symptoms such as seizures. The label also states that in some cases even short-term use of the drug may lead to dependance.
Effectiveness
Studies show that buspirone and alprazolam (Xanax) are equally effective at treating anxiety and its symptoms.
However, in this study, those taking alprazolam experienced more side effects such as fatigue, insomnia, drowsiness, and dry mouth.
Another study also found that alprazolam and buspirone were equally effective and more effective than placebo for generalized anxiety disorder (GAD).
However, patients showed quicker signs of improvement with alprazolam but more steady and continuous improvement with buspirone.
Healthcare providers use evidence-based medicine to make a well-informed decision about which medication is right for you.
They also consider your lifestyle, family medical history, personal medical history, other medications you take, the severity of your illness, and how consistent you are with your dosage.
Costs and Coverage
15-milligram buspirone is available at $12 for 30 tablets, but the price depends on your pharmacy and the drug brand.
0.25-milligram Xanax costs approximately $520 for 100 tablets, though again, the price varies at each pharmacy.
Check with your medical insurance provider about your coverage options for both.
Side Effects
Common side effects of buspirone include:
- Dizziness and lightheadedness
- Nausea
- Headache
- Blurred vision
- Nervousness or excitement
- Restlessness
- Dry mouth
- Insomnia
- Skin rash
- Diarrhea
- Muscle weakness
- Tingling sensation in hands and feet
- Confusion
Common side effects of Xanax (alprazolam) include:
- Fatigue
- Drowsiness
- Changes in weight and appetite
- Changes in memory ability
- Dizziness
- Lightheadedness
- Loss of sexual libido
- Nausea
- Diarrhea
- Constipation
- Slurred or slow speech
- Muscle weakness
- Swelling in hands and feet
Interactions
Certain medications can interact with buspirone and Xanax, so tell your medical provider about any other drugs you are consuming.
The below table depicts whether an interaction will occur.
| Buspirone | Xanax | |
| Opioids | No boxed warnings | Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. |
| MAOIs (monoamine) | Yes | No |
| CYP3A4 inhibitors | Yes | Yes |
| Antidepressants | Yes | Yes |
| Sedating antihistamines | Yes | Yes |
| Birth control pills | No | Yes |
Both drugs should not be taken with opioids, alcohol, other antidepressants, other anti-anxiety medications, or sedating antihistamines.
Warnings
Take your medication only as prescribed.
It can take time for your body to adjust to any drug.
Do not operate machinery (including driving vehicles) under the influence of medication until your body gets used to a drug.
If you are pregnant, thinking of getting pregnant, or have any concerns, consult your medical provider.
When to See a Medical Professional
If you have symptoms of anxiety that interfere with your daily life, seek help from a medical professional.
They can make a diagnosis and, if appropriate, discuss treatment options.
How K Health Can Help
Did you know you can get affordable primary care with the K Health app?
Download K Health to check your symptoms, explore conditions and treatments, and, if needed, text with a clinician in minutes. K Health’s AI-powered app is based on 20 years of clinical data.
Frequently Asked Questions
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
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Alprazolam in Chronic Tension Type Headache. (1996).
https://pubmed.ncbi.nlm.nih.gov/9251377/ -
Alprazolam Versus Buspirone in the Treatment of Outpatients With Generalized Anxiety Disorder. (1991).
https://pubmed.ncbi.nlm.nih.gov/1798836/ -
Anxiety Disorders - Facts & Statistics. (2022).
https://adaa.org/about-adaa/press-room/facts-statistics -
Buspirone for Anxiety and Agitation in Dementia. (2003).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC257799/ -
Buspirone for the Treatment of Dementia With Behavioral Disturbance. (2017).
https://pubmed.ncbi.nlm.nih.gov/28124634/ -
Buspirone vs Alprazolam: A Double-Blind Comparative Study of Their Efficacy, Adverse Effects and Withdrawal Symptoms. (2012).
https://link.springer.com/article/10.1007/BF03259411 -
Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. (2020).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786299/
