Buspirone and Alcohol: Interactions, Risks, and Safety

What Is Buspirone?

Buspirone (brand name BuSpar, though now primarily available as generic) is an anxiolytic medication FDA-approved for the treatment of generalized anxiety disorder. Unlike benzodiazepines (Xanax, Valium, Ativan), buspirone works primarily as a partial agonist at serotonin 5-HT1A receptors, modulating the serotonin system rather than enhancing GABA activity.

This different mechanism gives buspirone several advantages over benzodiazepines: it does not produce sedation at therapeutic doses, has no abuse or addiction potential, does not cause physical dependence or withdrawal, does not impair memory, and does not interact with alcohol as dangerously as benzodiazepines do. However, buspirone takes 2-4 weeks to reach full effectiveness (unlike benzodiazepines, which work immediately), making it unsuitable for acute anxiety relief.

Why Buspirone Is Sometimes Used in Addiction Treatment

Because buspirone effectively treats anxiety without addiction risk, it is sometimes prescribed for individuals in recovery from alcohol or benzodiazepine addiction who have co-occurring anxiety disorders. These patients need anxiety treatment but cannot safely take benzodiazepines due to their addiction history. Buspirone fills this gap. Some research also suggests buspirone may directly reduce alcohol consumption in heavy drinkers with anxiety, though evidence is mixed.

Buspirone and Alcohol: The Interaction

While buspirone is generally safer than benzodiazepines when combined with alcohol, the interaction is still clinically significant and should be avoided:

Enhanced CNS Depression: Both buspirone and alcohol act on the central nervous system. Their combined effects increase sedation, drowsiness, and cognitive impairment beyond what either substance produces alone.

Impaired Coordination: The combination worsens motor coordination and reaction time, significantly increasing the risk of falls, accidents, and impaired driving ability.

Increased Dizziness: Both substances can cause dizziness, and the combination amplifies this effect, potentially leading to dangerous falls, especially in older adults.

Unpredictable Effects: Individual responses to the combination vary. Factors including dose of each substance, body weight, liver function, and concurrent medications affect how severely the interaction manifests. Some people experience minimal additional effects; others become profoundly impaired.

Important caveat: While the buspirone-alcohol interaction is less dangerous than the benzodiazepine-alcohol interaction (which can be fatal through respiratory depression), it is still medically contraindicated. The FDA label for buspirone advises patients to avoid alcohol during treatment.

Safety Recommendations

If you are prescribed buspirone, follow these guidelines:

1. Avoid alcohol entirely while taking buspirone — this is the safest approach
2. If you do consume alcohol, discuss this honestly with your prescriber so they can assess your individual risk
3. Never drive after combining buspirone with any amount of alcohol
4. Do not take extra buspirone if you feel anxious after drinking — this increases the interaction risk
5. Tell your prescriber about all substances you use, including alcohol, cannabis, and over-the-counter medications
6. If you are in recovery from alcohol addiction and prescribed buspirone, any alcohol use should be discussed with your treatment team as a potential relapse signal

FAQ

Can buspirone help with alcohol cravings?

Some research suggests that buspirone may reduce alcohol consumption in heavy drinkers who also have anxiety disorders, likely by treating the underlying anxiety that drives self-medication with alcohol. However, buspirone is not FDA-approved for alcohol use disorder treatment, and evidence for this use is mixed. Medications with stronger evidence for alcohol cravings include naltrexone and acamprosate.

Is buspirone safer than Xanax for people with drinking problems?

Significantly safer. Benzodiazepines like Xanax combined with alcohol can cause fatal respiratory depression, and both substances are addictive. Buspirone does not carry addiction risk, does not produce dangerous respiratory depression when combined with alcohol, and does not have abuse potential. For patients with co-occurring anxiety and alcohol use disorder, buspirone is generally the preferred anxiolytic choice.

How long after drinking can I take buspirone?

There is no established safe interval because individual metabolism varies. As a general guideline, wait until alcohol is fully cleared from your system — at least 1 hour per standard drink consumed. For example, after 3 drinks, wait at least 3-4 hours. However, the safest approach is to not drink at all while taking buspirone and discuss any alcohol use with your prescriber.

References:

• FDA. (2023). Buspirone Hydrochloride Prescribing Information.
• Kranzler, H.R. et al. (1994). Buspirone Treatment of Anxious Alcoholics. Archives of General Psychiatry.
• National Institute on Alcohol Abuse and Alcoholism. (2024). Harmful Interactions: Mixing Alcohol with Medicines.
• Stahl, S.M. (2021). Stahl's Essential Psychopharmacology: Prescriber's Guide.

Valley Spring Recovery Center Editorial Team

This article was reviewed by the Valley Spring Recovery Center editorial team, comprising licensed therapists, medical professionals, and addiction specialists dedicated to providing accurate, evidence-based information about substance use disorders and treatment options.