Buspirone vs. Xanax: Differences, similarities, and which is better for you

Main differences | Uses | Efficacy | Side effects | Drug interactions | Warnings | Insurance & costs | FAQs

If you are experiencing anxiety symptoms, you are certainly not alone—40 million American adults, or 18% of the population, have anxiety. Buspirone (the generic name for BuSpar, which is no longer manufactured as a brand-name drug) and Xanax (alprazolam) are two FDA-approved anti-anxiety drugs that are popular treatment options for generalized anxiety disorder. Although buspirone and Xanax are both anxiolytics (drugs used in the treatment of anxiety), they have notable differences.

How does buspirone work?

Buspirone is an anti-anxiety medication and is not related to Xanax chemically. Buspirone is in a drug category, or class, of its own, and not related to any other medications used for anxiety. The way buspirone works is not completely understood. We do know that it is different from benzodiazepines like Xanax. Studies have shown that buspirone works on serotonin and dopamine receptors.

How does Xanax work?

Xanax is part of a large class of prescription medications known as benzodiazepines. Benzodiazepines work by increasing activity at receptors for a neurotransmitter called gamma-aminobutyric acid (GABA). This all takes place in the CNS (central nervous system). Benzodiazepines produce a relaxing, calming effect and can even help promote sleep when taken at bedtime. Xanax is a controlled substance and is classified as a Schedule IV drug. This means it has some potential for abuse and dependence. 

Uses of buspirone and Xanax

Buspirone and Xanax are most commonly used in the management of anxiety disorders and can help in the short-term relief of symptoms of anxiety, whether or not anxiety is associated with depressive symptoms. 

Xanax is also used to treat panic disorder, or panic attacks, with or without agoraphobia (fear of crowded places, or fear of leaving the home). 

Both drugs also have a variety of off-label uses, including alcohol withdrawal, bruxism (teeth grinding), depression, post-traumatic stress disorder, premenstrual syndrome, and others.

Is buspirone or Xanax more effective?

In a study comparing buspirone and Xanax, both drugs were found to be equally effective in treating symptoms of anxiety. Buspirone was found to have fewer side effects and fewer withdrawal symptoms than Xanax.

Another study looked at the effect on daytime sleepiness between buspirone vs. Xanax vs. Valium (diazepam). The study found buspirone to cause the least drowsiness of the three drugs. By the end of the first week of treatment, the difference between the drugs in terms of daytime sleepiness was not significant, but people who took Xanax or Valium had slower reaction times on a visual reaction timed performance test. The authors concluded that although the drugs are similarly effective, buspirone may be better in patients where daytime alertness is critical.

The most effective medication for you should only be determined by your doctor, who can look at your medical condition(s) and history, as well as other medications you take.

RELATED: How effective is buspirone for anxiety?

Potential risks of buspirone vs. Xanax

Side effects

The most common side effects of buspirone are dizziness (12%), drowsiness (10%), and nausea (8%). Other common side effects may include:

• Headache
• Trouble sleeping
• Nervousness
• Fatigue
• Dry mouth 
• Difficulty concentrating
• Hostility
• Confusion
• Depression
• Blurry vision
• Stomach pain and diarrhea
• Numbness 
• Weakness

The most common side effects of Xanax are drowsiness (41%), light-headedness (21%), and dry mouth (15%). Other common side effects may include:

• Fatigue
• Impaired coordination
• Irritability
• Amnesia
• Changes in appetite
• Confusion
• Difficulty speaking
• Dizziness
• Difficulty concentrating
• Changes in libido
• Urinary problems
• Irregular menstrual cycle
• Low blood pressure
• Drooling
• Double vision

This is not a full list of side effects, and others may occur. Consult your healthcare professional for a full list of adverse effects.

Food and beverage interactions

Avoid grapefruit and grapefruit juice while taking buspirone or Xanax. Grapefruit interacts with these medications and may cause the medicine to build up in your body, increasing the risk for serious side effects. 

While taking buspirone or Xanax, you should avoid alcohol. Alcohol can increase the risk of side effects and impairment and can cause slowed breathing, severe sedation, loss of consciousness, and coma. 

Drug interactions

Before taking buspirone or Xanax, tell your healthcare provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements. 

Buspirone should not be taken within 14 days of a monoamine oxidase inhibitor (MAOI). The combination can lead to a dangerous increase in blood pressure, or a condition called serotonin syndrome, which is a life-threatening condition and medical emergency.

Xanax comes with a boxed warning, the strongest warning required by the U.S. Food and Drug Administration (FDA). Xanax (or any medicine in the benzodiazepine class of drugs) should not be taken with opioid painkillers because of the risk of extreme sedation, severe respiratory depression, coma, and/or death. If the combination of a benzodiazepine and opioid cannot be avoided, the patient should be prescribed the lowest dose for the shortest period of time and be closely monitored. 

The warning also states that benzodiazepines like Xanax have the potential for abuse and can cause overdose or death. Patients will be assessed for the risk of abuse before taking Xanax and will be closely monitored while taking Xanax. Additionally, the warning notes that because benzodiazepines can cause physical dependence, they should never be abruptly stopped. Rather, when discontinuing Xanax, the healthcare professional will provide the patient with a tapering schedule to slowly and safely stop taking Xanax.

Other drug interactions may occur. Consult your healthcare provider for medical advice.

RELATED: Does caffeine interact with buspirone?

Other warnings

Before taking either anxiety medication, talk to your doctor about all of the medical conditions you have, and all of the medications you take, so your doctor can determine if buspirone or Xanax is safe for you. 

• Do not drive or operate machinery until you know how buspirone or Xanax affects you.
• Do not drink alcohol with buspirone or Xanax.

Buspirone warnings

• Patients with severe liver or kidney problems should not use buspirone.
• Serotonin syndrome is a life-threatening condition caused by the buildup of serotonin. It is a medical emergency. Symptoms may include agitation, hallucinations, fever, chills, sweating, fast heart rate, stiff muscles, twitching, incoordination, or stomach problems like nausea, vomiting, or diarrhea. Certain drugs, when combined with buspirone, can increase serotonin levels and increase the risk of serotonin syndrome. These may include opioid pain medications, antidepressants, triptans for migraine, the supplement St. John’s Wort, the cough suppressant dextromethorphan (found in many cough and cold medications), and others. 
• Buspirone has been studied in pregnant animals and showed no harm to the fetus, but there are no adequate studies in pregnant women. Therefore, buspirone should only be used in pregnancy if clearly needed and if approved by your OB/GYN.

Xanax warnings

• Xanax may cause physical and psychological dependence. The risk of addiction increases with large doses, longer duration of use, or a history of substance abuse. Because patients with panic disorder often use higher doses of Xanax, there may be a higher risk of dependence.
• If you take Xanax, take only as prescribed. Do not take additional doses.
• When discontinuing Xanax, ask your doctor for a plan to taper the medication slowly. This will help you avoid withdrawal symptoms, which may include seizures, agitation, confusion, rapid heartbeat, vertigo, and other symptoms. Patients with seizure disorders are at higher risk for withdrawal symptoms.
• There is a risk of suicide in patients with depression. Patients with depression should be treated with an antidepressant and should be closely monitored.
• Xanax should be used with caution in patients with lung problems such as chronic obstructive pulmonary disease (COPD) or sleep apnea.
• Talk to your doctor about adjusting the dose of Xanax if you have liver problems.
• Xanax is on the Beers List (drugs that may be inappropriate for use in older patients). Because older adults have increased sensitivity to benzodiazepines, there is an increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes when Xanax is used.
• Xanax should not be used in pregnancy, because it can cause harm to the fetus. If you are already taking buspirone or Xanax and find out that you are pregnant, contact your OB/GYN immediately.

Insurance coverage and cost comparison

Buspirone and generic Xanax are usually covered by insurance as well as Medicare Part D, although copays will vary. 

Brand-name Xanax is much more expensive than generic Xanax and may not be covered by insurance. You can ask your healthcare provider if you can take generic Xanax (alprazolam) instead to get better insurance coverage and pay much less for your prescription.

Buspirone typically retails around $35 but you can get it for $3 by using a SingleCare coupon at participating pharmacies. Xanax prices range from $92 (generic) to $246 (brand) but you can get a prescription of 90, 1 mg tablets for as low as $2 with a SingleCare coupon.

RELATED: Try the SingleCare discount card

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the coupon buttons to see updated drug prices.

Frequently asked questions about buspirone vs. Xanax

Are buspirone and Xanax the same?

While they both treat anxiety, they work differently. The way buspirone works is not quite understood but involves serotonin and dopamine. Xanax (and other drugs in the benzodiazepine class) works on GABA receptors in the brain.

Is buspirone a substitute for Xanax?

Buspirone is not a generic substitute for Xanax, but it might be a better option. Buspirone and Xanax work differently, but they both treat anxiety. Patients taking buspirone tend to experience less sedation. Ask your doctor if one of these drugs is right for you.

Is buspirone or Xanax better?

In clinical studies, both drugs were shown to be equally effective for anxiety. However, buspirone may cause less daytime drowsiness.

That being said, both drugs are very popular. Because everyone is different, it is best to check with your doctor and he/she can review your current symptoms and medical history as well as other medications you take, to determine if buspirone or Xanax is better for you.

Why is buspirone preferred over a benzodiazepine, like Xanax?

Buspirone has fewer side effects. While Xanax and other benzodiazepines are controlled substances, buspirone is not a controlled substance, so it does not have the risk of abuse and dependence. 

Can I use buspirone or Xanax while pregnant?

Buspirone is a pregnancy category B. Studies in animals showed no harm to the fetus, but there are no adequate studies in pregnant women. Therefore, buspirone should only be used in pregnancy if the benefits outweigh the risks, and under the supervision of your OB/GYN.

Xanax is a pregnancy category D. Taking the drug while pregnant can cause harm to the baby, and it should not be used. 

If you are already taking buspirone or Xanax and find out that you are pregnant, contact your OB/GYN immediately.

RELATED: What medications are safe to take during pregnancy?

Can I use buspirone or Xanax with alcohol?

No. The combination of buspirone or Xanax with alcohol can be very dangerous or even deadly. Together, alcohol plus buspirone or Xanax can lead to CNS depression (slowed brain activity), respiratory depression (slowed breathing and not getting enough oxygen), and even lead to coma and/or death.

Is brand-name BuSpar still available?

Brand-name BuSpar is no longer available in the United States. However, the generic formulation (buspirone) is widely available.