Problematic Use of Buspirone and Tandospirone: A Scoping Review

Objectives: Azapirone-class drugs are partial 5-HT1A receptor agonists commonly used to treat anxiety disorders. Prior experimental studies have so far demonstrated that these drugs have low potential for dependence and problematic use and are considered safe treatment options compared with benzodiazepines. However, recent evidence suggesting the contrary raises concerns about their safety. This review examines current evidence on problematic azapirone use. Methods: This study was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Major databases, including MEDLINE/PubMed, PsycInfo, and EMBASE, were searched to identify eligible papers. Additional searches were conducted to supplement. Article selection and data extraction were completed by at least 2 independent reviewers. Results: Thirteen reports made up of clinical studies (n = 9) and case reports (n = 4) were included. All abuse liability studies comparing azapirones (buspirone and tandospirone), benzodiazepines, and placebo reported no association of buspirone and tandospirone with key features of problematic use. Conversely, all case reports (n = 4) described problematic use, involving patients with a history of incarceration or substance use disorder (SUD) who insufflated buspirone to achieve a sedative effect. Conclusions: Findings highlight a discrepancy in the primary literature. Specifically, experimental studies conclude that so far, buspirone and tandospirone have a low potential for problematic use. However, more recent case reports document instances of nonprescribed buspirone misuse, particularly among individuals with a history of incarceration or SUD, possibly stemming from a complex interplay of biopsychosocial-behavioral rather than purely pharmacological factors. Further research is needed to guide strategies for preventing problematic azapirone use while ensuring effective anxiety treatment in high-risk populations.