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Buspar And Orthostatic Hypotension Or Lowered Blood Pressure


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#1 NicScraps

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Posted 22 September 2007 - 11:24 AM

I've read what I can find about BuSpar, and don't see much that indicates that it really should lower your blood pressure significantly or cause orthostatic hypotention. Nevertheless, it seems to have done so in my case. [Note that some drug interaction sites do mention blood pressure lowering with ANY CNS active med plus any antihypertensive, but nothing specific about BuSpar that I have found.]

I have chronic (benign essential) hypertension. I've been on meds for it for about 16 years now. The probability that I've been "cured" overnight of my hypertension is about zero.

I started BuSpar about 4 weeks ago. I am now up to 40 mg/day, divided, and have been at that dose for 2 weeks (plenty of time to reach steady state with this med).

What I've been noticing is that my blood pressure is much lower than usual, and I'm having some lightheaded/dizzy spells upon standing, which act like orthostatic hypotension (I had a lot of orthostasis when I was pregnant, so I'm quite familiar with it). Checking my blood pressure right after one of these episodes confirms that the pressure is pretty low (and super low for someone like me).

I've notified my internist, and will discuss it with the pdoc next month. In the mean time, I'm getting up very slooooowly. I can certainly cut back on my antihypertensive meds and monitor my pressures at home whenever I feel that I need to do that (it's fine with my doc).

My questions for any of you who have taken BuSpar are:

(1) Did you notice that it lowered your blood pressure, either by measurements or by starting to have episodes of orthostatic hypotension?

and

(2) Did you ever have episodes of what seemed like orthostatic hypotension while on BuSpar, regardless of your blood pressure readings?

Thanks so much -
Nicole
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Dx: Depression, anxiety, panic attacks, OCD, possibly bipolar II ???, plus hypertension
Rx: Lamictal 150 mg, Prozac 20mg, BuSpar 20 mg, Ambien 5 mg, plus Benicar for hypertension

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#2 Cyeic

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Posted 22 September 2007 - 01:15 PM

From the Main CM BuSPar SE page:

BuSpar's less common side effects: Blood pressure changes.


From the PI sheet:

Cardiovascular
Frequent was nonspecific chest pain; infrequent were syncope, hypotension, and
hypertension; rare were cerebrovascular accident, congestive heart failure, myocardial
infarction, cardiomyopathy, and bradycardia.


So although blood pressure changes are infrequent, the do occur. You'll have to make sure both your doctors know the medication you're on (get information over suitability from them both).
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#3 NicScraps

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Posted 22 September 2007 - 03:21 PM

From the Main CM BuSPar SE page:

BuSpar's less common side effects: Blood pressure changes.


From the PI sheet:

Cardiovascular
Frequent was nonspecific chest pain; infrequent were syncope, hypotension, and
hypertension; rare were cerebrovascular accident, congestive heart failure, myocardial
infarction, cardiomyopathy, and bradycardia.


So although blood pressure changes are infrequent, the do occur. You'll have to make sure both your doctors know the medication you're on (get information over suitability from them both).

Thank you, Cyeic. I did read both of those, but tend to NOT really expect things labeled as "less common" and "infrequent." Sorry, I didn't explain that very well in my original post.

Anyhow, that's why I was a bit surprised that it is so clearly happening for me, and the cause/effect relationship seems pretty clear. I posted the inquiry because I was just curious if others might have experienced it (though it really shouldn't surprise me much to find out that I fall into a "less common" or "infrequent" category. LOL)

What's sort of interesting about this (to me), is that I saw a profound antihypertensive effect from IV magnesium sulfate when I was given it in the hospital after my second child was born. Officially, mag does NOT lower your blood pressure, but it sure did mine. They use it during a post-partum antihypertensive crisis to prevent seizures because it alters your seizure threshold, not because it lowers the blood pressure (supposedly, it doesn't normally, at least so they kept telling me -- all evidence to the contrary, in my case). Actually, one nurse did admit to me that they do see it sometimes, but it's not considered a normal effect of the mag. Of course, the knowledge of those providers could be suspect. They don't see too many people like me at the OB ward at that hospital (most of them get shipped to Big City Medical Center if it looks like things are going to go so far south with the Mom.)

Yes, both docs do know my full med profile. I am sure I will have to adjust my antihypertensive if we go up any further with the BuSpar. My only two seizures in my life were following episodes of syncope, so we generally consider it a BAD idea for me to lose consciousness like that.

Nicole

Edited by NicScraps, 22 September 2007 - 03:29 PM.

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Dx: Depression, anxiety, panic attacks, OCD, possibly bipolar II ???, plus hypertension
Rx: Lamictal 150 mg, Prozac 20mg, BuSpar 20 mg, Ambien 5 mg, plus Benicar for hypertension

"The only courage that matters is the kind that gets you from one moment to the next." Mignon McLaughlin

#4 Cyeic

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Posted 23 September 2007 - 09:21 AM

Unfortunately, as I've mentioned elsewhere on threads, just because a side effect is rare it doesn't mean it won't happen to you. It's possible that either your preexisting condition/meds amplified the effect, or, that you're just one of the unlucky people who turns a non-occuring side effect into one that appears on the PI sheet.

Officially, mag does NOT lower your blood pressure, but it sure did mine


I have limited knowledge of this, (although I do know that magnesium in general plays a role in vascular function - see Here ) but just looking around a few sites:

Side effects are common with magnesium sulfate and can affect both the mother and fetus. Side effects are closely monitored and can include:

* Low blood pressure and fast pulse.


Source: WebMD

I find lots of references to low blood pressure with IV Magnesium Sulphate.

I have however found a possible mechanism for hypotension mediated by Buspirone:

Buspirone-induced hypotension is likely mediated through 5-HT1A receptors located on the cell bodies of the sympathoexcitatory neurons in the rostroventrolateral medulla (Kubo et al., 1995). (...)

....

(...) Agonism at 5-HT1A receptor-bearing neurons of the rostroventrolateral medulla, causes a reduction in the sympathetic outflow leading to systemic hypotension (Bago and Dean, 2001).


Effect of the 5HT1A receptor partial agonist buspirone on colorectal distension-induced pseudoaffective and behavioral responses in the female Wistar rat
Digavalli V. Sivarao, Kimberly Newberry and Nicholas J. Lodge
European Journal of Pharmacology
Volume 494, Issue 1, 21 June 2004, Pages 23-29


Source: Here

It might be an idea to look into medications which are not known to effect blood pressure - however, I'm sure if you've got two full informed docs on the case, they will be able to sort out the correct dosages that don't put you at greater seizure risk.
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#5 Silver

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Posted 23 September 2007 - 03:37 PM

OK. Had a long post, then realized it was, como se dice, wrong.

But:
Buspirone is on the hit list at our local nursing home inpatient pharmacy for problems with postural hypotension. Anyone who prescribes it is roundly scolded and asked if they wish to reconsider the treatment plan. I will have to ask them to back that up with some cites. (I'm sure that will go well.) It's infrequent... but if anyone is going to hit the ground, it's the elders, and they're the ones we can least afford to have fall down.

And here's another article on buspirone and blood pressure. Abstract only, unless you read Russian.


In a stunning 180 from my original post, I'm going to say: It's kind of odd that it's associated with a drop in blood pressure, since it's an alpha-2 antagonist (think yohimbine.) Blocks some clonidine effects, even, if you're a rat.
So I'll definitely be asking for some cites from the RPh re: the postural hypotension concern. The FPs get tired of being yelled at over this.


Cye: My officemate (who reads over my shoulder too often) now has taken to excusing herself to go to the bathroom citing a colorectal distension-induced behavioral response. Thanks a lot.

Edited by Silver, 23 September 2007 - 04:40 PM.

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#6 NicScraps

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Posted 23 September 2007 - 05:15 PM

So I'll definitely be asking for some cites from the RPh re: the postural hypotension concern. The FPs get tired of being yelled at over this.

If your RPh or PharmDs come up with any really good human data, I'd be interested from a mostly academic perspective.

I now know that it certainly has that effect on me, but being an N of 1, I'd hardly call myself "data". LOL

ROFL about the workmate!

Thanks again -
Nicole
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Dx: Depression, anxiety, panic attacks, OCD, possibly bipolar II ???, plus hypertension
Rx: Lamictal 150 mg, Prozac 20mg, BuSpar 20 mg, Ambien 5 mg, plus Benicar for hypertension

"The only courage that matters is the kind that gets you from one moment to the next." Mignon McLaughlin

#7 In_Remission_Hopeful In WA

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Posted 08 October 2007 - 05:12 PM

My questions for any of you who have taken BuSpar are:

(1) Did you notice that it lowered your blood pressure, either by measurements or by starting to have episodes of orthostatic hypotension?

and

(2) Did you ever have episodes of what seemed like orthostatic hypotension while on BuSpar, regardless of your blood pressure readings?

Thanks so much -
Nicole



I'm on several of the same meds as you and yes, I've noticed that even with the 30mg BuSpar that I take, if I stand up too fast, I get very dizzy. Trying to take 20mg at one time makes me so nauseated, I can't get out of bed or off the recliner or sofa for about 90 minutes after taking the dose. I've always had low blood pressure to begin with so for me, 30mg is about the highest we can go. Too bad it does work decently well for me. At least I can still have emotions on this med. Paxil zombified me, Celexa just made me dead below the neck, and Lexapro made me 100% angry 100% of the time with no other emotion. I think for now, I'll put up with the dizzies if it means some measure of something approaching sanity.

#8 NicScraps

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Posted 08 October 2007 - 06:04 PM

Thanks for sharing that. When I told the pdoc about the orthostasis and my belief that it was the BuSpar, he was like "Well, I've heard of that, but it's very rare."

I don't want to go back down on the BuSpar. Current dose of 40mg/day actually seems to DO something for me, and for a change it's something helpful instead of a nasty side-effect.

I also find that the episodes seem to come and go from day to day. Mild dehydration can cause or exacerbate orthostatic hypotension, so maybe the key is to be a bit more vigilant about drinking lots of water. I'm going to drink a big glass of water the next time I get a woozie episode, and see if that seems to help.

Nicole
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Dx: Depression, anxiety, panic attacks, OCD, possibly bipolar II ???, plus hypertension
Rx: Lamictal 150 mg, Prozac 20mg, BuSpar 20 mg, Ambien 5 mg, plus Benicar for hypertension

"The only courage that matters is the kind that gets you from one moment to the next." Mignon McLaughlin

#9 In_Remission_Hopeful In WA

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Posted 09 October 2007 - 09:13 AM

Thanks for sharing that. When I told the pdoc about the orthostasis and my belief that it was the BuSpar, he was like "Well, I've heard of that, but it's very rare."

I don't want to go back down on the BuSpar. Current dose of 40mg/day actually seems to DO something for me, and for a change it's something helpful instead of a nasty side-effect.

I also find that the episodes seem to come and go from day to day. Mild dehydration can cause or exacerbate orthostatic hypotension, so maybe the key is to be a bit more vigilant about drinking lots of water. I'm going to drink a big glass of water the next time I get a woozie episode, and see if that seems to help.

Nicole


Oh man, I can't remember right now where I read it but I HAVE read that we should be taking our BuSpar with full glasses of water every time. I take mine three times a day in 10 mg doses because anything more than that makes me even more queasy than I already am most of the time.

#10 mj1127

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Posted 09 October 2007 - 12:57 PM

This was the reason I stopped taking Buspar years ago - something about almost passing out in public several times just didn't appeal to me.
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#11 NicScraps

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Posted 09 October 2007 - 01:12 PM

This was the reason I stopped taking Buspar years ago - something about almost passing out in public several times just didn't appeal to me.

Yes.

I'm getting a tad bit off-topic here, but I had horrible orthostatic hypotension when pregnant, and had one episode at Wal-Mart where I actually laid down on the floor in the middle of the laundry detergent aisle. The nearest Wal-Mart employee, a young male, looked like HE might pass out himself from fear that he might have to help me. He practically sprinted away when I reassured him that I was OK, and did not need any assistance. :mad:

N
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Dx: Depression, anxiety, panic attacks, OCD, possibly bipolar II ???, plus hypertension
Rx: Lamictal 150 mg, Prozac 20mg, BuSpar 20 mg, Ambien 5 mg, plus Benicar for hypertension

"The only courage that matters is the kind that gets you from one moment to the next." Mignon McLaughlin

#12 Silver

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Posted 09 October 2007 - 01:22 PM

Hey, Nicole, here's another "it has an antihypertensive effect in overseas rats" article for you. I don't think it's already cited above.
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#13 laursmd

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Posted 14 March 2008 - 04:02 AM

I had all these same sx, low bp readings, orthostasis, after starting Paxil. My bp has been on the pretty high side in the past and as soon as I started Paxil....I got a reading of 90/60 one day.....low low low for me. Off the Paxil, my readings are in the 120's over 70's, and this is also having d/c'd my diuretic.
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#14 veronicadolittle

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Posted 20 September 2011 - 11:02 AM

Has anyone had the experience of getting used to the med after a while and the dizzy spells going away? I normally have low blood pressure, and I think the buspar is making it worse. About half an hour after taking it I get really dizzy, and it lasts for a good 30-45 min. I have to lay down during that time. I'm still in the stage where we are upping my dose, so I'm hoping it is one of those side effects that your body can get used to over time?
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#15 lobotomy1012

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Posted 22 September 2012 - 07:56 PM

I don't know if this will help, but this is my experience...I am taking Spironolactone for back acne and was warned about having lowered BP at first in reaction to the med, but then was told that over time my body should get used to it, which was exactly what happened. I never noticed it too much even at first, except if I had a dr's appt and they checked my BP.
Recently I tried Buspar for anxiety, and it turns out that there is an interaction with Spironolactone...it causes hypotension, but I only noticed it at my eye dr when my BP was 80/50 and it is normally 115/75. (I had been feeling fine). I was on Buspar for 6 weeks and it was not helpful for me, so as soon as I dropped it, my BP started going back up.
Point being, as long as its the Buspar alone and not an interaction, your body might get used to it (definitely check with your dr. on this theory), but if it's an interaction, I would be less hopeful. I would check for interactions online and definitely with your dr. Being that dizzy means your BP is probably pretty low.
I have to call my pdoc Monday because Seroquel XR + Spiro knocked down my BP so low yesterday (dose 1) I had to hold on to things to walk in my house...I knew as soon as I felt dizzy/light-headed I needed to check online for the drug interaction, and there it was.
I am sorry you are having this issue. I know it's frustrating, plus you just feel like crap.
Good luck!
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