Prior Benzodiazepine Use and Buspirone Response in the Treatment of Generalized Anxiety Disorder

Department of Psychiatry, University of Pennsylvania, Philadelphia 19104-2649, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/2000; 61(2):91-4. DOI: 10.4088/JCP.v61n0203
Source: PubMed


An earlier preliminary report suggested that prior treatment with benzodiazepines might predict a reduced response to buspirone in patients diagnosed with generalized anxiety disorder (GAD). To confirm or refute this hypothesis, the present data analysis was conducted.
One large data set (N = 735) of GAD patients (DSM-III) treated with buspirone, a benzodiazepine, and a placebo was analyzed by dividing all patients into 3 prior benzodiazepine (BZ) treatment groups: no prior BZ treatment, recent (< 1 month) BZ treatment, and remote (> or = 1 month) BZ treatment. Using an intent-to-treat last-observation-carried-forward (LOCF) data set, acute 4-week treatment response was assessed in terms of clinical improvement, attrition, and adverse events as a function of these 3 prior benzodiazepine treatment groups.
Patient attrition was significantly higher (p < .05) in the recent BZ treatment group than in the remote and no prior BZ treatment groups with lack of efficacy given as the primary reason by patients receiving buspirone but not benzodiazepine or placebo. In the buspirone group, adverse events occurred more frequently in the recent BZ treatment group than in the remote BZ treatment and no prior BZ treatment groups. Finally, clinical improvement with buspirone was similar to benzodiazepine improvement in the no prior BZ treatment and remote BZ treatment groups, but less than benzodiazepine improvement in the recent BZ treatment group, leading to the smallest buspirone/placebo differences in improvement in the recent BZ treatment group.
These data suggest that the initiation of buspirone therapy in GAD patients who have only recently terminated benzodiazepine treatment should be undertaken cautiously and combined with appropriate patient education.

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    • "Though the BH is potent drug; it has a wide therapeutic window making the drug safe for its use in variety of patients . [DeMartinis N 2000, Sachs DP 1991, Farid P 1998]. Approximately 1 to 1.5 mg of drug out of 20-30 mg administered dose per day is actually responsible to create ordinary therapeutic effect. "
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    ABSTRACT: The present work was intended to design alternative dosage form to the conventional tablets of the Buspirone hydrochloride (BH); as about 96% drug is metabolized during its first pass by oral route. An adhesive matrix system of BH was prepared by taking different ratios of Polyvinylpyrrolidone K30 (PVP) and Hydroxypropyl methylcellu-lose LMV (HPMC) with polyethylene glycol 400 (PEG) as plasticizer. Oleic acid was incorporated as penetration enhancer and sodium lauryl sulfate (SLS) as solubilizer in the hydroalcoholic solution. Resultant solution was dried on the Polyvinyl Alcohol EF (PVA) backing membrane to prepare adhesive matrix type transdermal patch. Physical evaluation of the adhesive matrix layers obtained by the various combinations of PVP and HPMC were carried out by performing thickness uniformity, ultimate tensile strength, peel adhesion, ball adhesion and moisture absorp-tion studies. Permeation studies were performed using Keshary-Chien diffusion cell through human cadaver skin in 10% buffered formalin (7.4pH). Approximate zero order release kinetics was observed when a patch containing 4 mg/cm 2 of BH created a flux of 42µg/cm 2 h -1 and penetrated about 1mg/cm 2 of drug in a day. Transdermal patch of BH provides a superior option to conventional tablets and creates reasonable change in the drug therapy of anxiety patients.
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    The Journal of Clinical Psychiatry 09/2001; 62(8):653-5. DOI:10.4088/JCP.v62n0813b · 5.50 Impact Factor
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