Posted by zeugma on January 8, 2006, at 10:24:52
In reply to Re: Buspar stories? Weight gain? » Racer, posted by yxibow on January 7, 2006, at 13:22:41
A weak, atypical antipsychotic that failed to meet standards for that class and so BuSpar it became for anxiety.>>
it's worth noting that at the time of BuSpar's development, the atypical class consisted solely of clozapine, and the term 'atypical' had not been invented.
Buspirone has been referred to as an atypical antidepressant in the literature with some frequency, which of course means nothing.
Also, BuSpar has been used for the treatment of ataxia.
The point you make about buspirone being implicated in AP-like side effects at very high dosesis borne out, however, by this case study (dosages above 30 mg/day btw are considered "high," and the man, after discontinuing the offending antiretroviral, was able to tolerate 45 mg/day buspirone without ill effects) :
<<1: Ann Pharmacother. 2003 Feb;37(2):202-5.
Pseudo-Parkinson disease secondary to ritonavir-buspirone interaction.Clay PG, Adams MM.
Department of Pharmacy Practice, University of Missouri-Kansas City, Kansas City, MO 64108-2792, USA. claypg@umkc.edu
OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug-drug interaction. CONCLUSIONS: This case demonstrates a severe drug-drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.>>
-z
poster:zeugma
thread:594004
URL: http://www.dr-bob.org/babble/20060108/msgs/596536.html