Buspirone in the Treatment of Alcoholic Patients

Abstract

Buspirone is a unique anxiolytic drug with established efficacy in the treatment of anxiety. In animals, buspirone has been shown to alter drinking preference from alcohol to water. The following study was conducted to evaluate the behavioral effects of buspirone in patients meeting the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III) criteria of alcohol abuse. These patients were motivated to reduce or stop drinking, though none were abstinent at baseline. Buspirone was compared with placebo in a double-blind, 8-week trial in 50 outpatients with mild to moderate alcohol abuse. Patients were assessed at baseline and at end point using the following psychometric and alcohol behavior measures: Drinking Behavior Interview (DBI), Alcohol Craving Scale, the Hamilton Anxiety (HAM-A) Rating Scale, the Hamilton Depression (HAM-D) Rating Scale, and the Physician Questionnaire. Dosage was initiated at 5 mg buspirone 3 times a day (15 mg/day), with a flexible regimen to a maximum of 30 mg/day. The mean daily dose was 20.5 mg buspirone, which is comparable to the anxiolytic dose. Efficacy measures were available for 45 patients (24 buspirone, 21 placebo). The treatment discontinuation rate was markedly lower (p = 0.002) on buspirone; 12 placebo patients and 2 buspirone patients discontinued due to lack of effect (p = 0.001). No patients discontinued due to adverse effect. Buspirone reduced alcohol craving by 40% (p = 0.001), in association with reduced HAM-A and HAM-D scores (p = 0.006) and improved the physician’s assessment of global psychopathology. Buspirone treatment was also associated with a 57% decrease in DBI scores; statistical comparison of the DBI data with placebo was precluded by the high discontinuation rate in the placebo group. While these results should be interpreted with caution due to the limited sample size and high placebo discontinuation rate, the findings suggest that further evaluation of buspirone in the management of alcoholism, especially abstinent alcoholics, is warranted.

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings

“…In a review of five published trials, buspirone was without a convincing effect in non-comorbid alcoholics; however, alcoholics with comorbid anxiety experienced some benefit [193,194]. Hence, buspirone's anxiolytic effects might translate to those who also are dependent on alcohol.…”

A 5-HT1A agonist and a 5-HT2c antagonist reduce social interaction deficit induced by multiple ethanol withdrawals in rats

“…It has been previously determined that buspirone, a 5-HT 1A receptor partial agonist, will reduce the anxiety-like symptoms associated with withdrawal from ethanol (Dougherty and Gates 1990;Lal et al 1991;File et al 1993), but its success as a treatment in alcoholics has been mixed (Bruno 1989;Kranzler and Meyer 1992;Malcolm et al 1992;Tollefson et al 1992;Malec et al 1996;Fawcett et al 1999;George et al 1999). Recently, a selective 5-HT 2C receptor antagonist, but not 5-HT 1A or 5-HT 3 receptor antagonists, blocked the reduction in social interaction following withdrawal from chronic ethanol exposure (Knapp et al 2000).…”

Pharmacotherapy of Alcohol Use Disorders: Seventy-Five Years of Progress

“…This nonbenzodiazepine anxiolytic became an attractive treatment for anxiety in alcoholics because it is less sedating than benzodiazepines, does not add to alcohol's impairment of psychomotor functions, and has no apparent abuse potential (Goa and Ward 1986). In a double-blind study in patients with a mild-to-moderate alcohol use disorder (Bruno, 1989), buspirone-treated subjects showed a greater reduction in anxiety and a higher rate of retention in treatment than those assigned to placebo, but at 8 weeks alcohol consumption did not differ signifi cantly between the groups. In a trial in abstinent alcoholics with co-occurring generalized anxiety disorder (Tollefson et al, 1992), there was greater treatment retention and anxiety reduction with buspirone than placebo.…”