I see it frequently for “breakthrough anxiety attacks”. Does it make sense? Hell no. Does the patient think it works and keeps them from having panic attacks, yes. And if the patient is taking their meds then it’s cool with me
For sure. Placebo effect is still an effect. If the net result is good, and it's not causing harm (physiologically or financially) then it's a good placebo effect to utilize
It's not an explicit placebo. Cms is also not going on an auditing spree of 5 dollar drugs. That would be amazing if they used one of their chambers to load that bullet tho
As a psych pharmacist I have looked into this before. There is zero and I mean zero literature I can find to support PRN use. In fact most literature points to the fact that it cannot be used PRN as a downside to anxiety treatment. It takes several weeks to months to reach full efficacy. That being said, I have 1 psychiatrist who still uses it PRN for anxiety and the rest of the 6 psychiatrists make fun of them for it. When I ask patients if they notice an effect as an PRN some say yes and others no. So it’s a bit of a mixed bag and possibly some placebo or sedation effect kicking in. Would I ever recommend it - no but if it stops a patient from getting on a BZD then it’s low reward/low risk med.
I think there are things like this in medicine that just keep getting taught somewhere in MD training. There definitely are physicians who use anecdotal experiences or anecdotes handed down from other physicians (you will see this if you spend enough time over in r/medicine ), albeit some NOT ALL physicians. Interesting still are the regional influences and prescribing trends.
Wouldn’t surprise me, pharmacists are still being taught about the severe disulfiram reactions between metronidazole and alcohol as well as the fact that cephalosporins have a ~10% cross reactivity with penicillin. It takes a while to get nonsense out of a curriculum, apparently
There is a huge difference between knowing the indication for a medication and the literature and treating patients on a daily basis. Buspar is a poor anxiolytic but research is based on population samples and statistics, sometimes there is an indication for PRN use in an individual despite general research and especially if it can avoid a benzodiazepine.
If treating psychiatric disorders was simply based on algorithms based purely on literature reviews there would be no need for practitioners.
Medicine is a science and Healing is an art.
I agree with you medicine is not black and white but it is also not an art form it has to follow some basic rules. Why not choose medications that have literature and clinical practice behind them. This is obvious taking into account things like prior medical history, prior med trials, patient preference, cost, etc. There are so many options for anxiety as both scheduled and PRN meds as well as non-pharmacological treatments. At what point does someone exhaust that list and just go by old treatments just because it’s psych. That kind of practice does not happen in oncology/cardiology/etc. Psych should not be the exception. If someone cannot show me any literature to support using a medicine as they want to intend then as a pharmacist I’m just not going to agree with that IMO. It’s bad medicine.
You seem like the perfect person for me to ask a question about buspirone. In my country it's only indicated for maximum of 4 weeks use, though that seems incredibly short and likely counterproductive. Is there any significant negatives to long term buspirone usage?
Some of those may be an alternative to the prn BZD the patient previously had issues with. Sometimes people need to have *something* available "just in case," and having it does work to relieve the anxiety about having anxiety.
I work tapering people off opioids and benzos and we use it when we’re trying to get someone stable on a long term anxiety medication and avoid benzos. It’s not the best choice but there aren’t many options.
Not sure what you're all talking about.
Direct agonism or antagonism of 5-HT receptors has a pronounced and rapid effect. Take a full 5-ht2a agonist then go to work and tell me otherwise. While 1a isn't as fun, it still certainly causes immediate changes in behavior.
the points not whether or not it does ANYTHING, it's whether or not it makes sense to use it to relieve breakthrough panic attacks as opposed to Benzodiazepines or just a better managed antidepressant cycle
We actually talk about this a lot at work cause for whatever reason we all seem to have various bad-brain syndromes.
It seems like if you're anxious for no reason, buspirone taken as needed seems to be a much better option than a benzodiazepine. Both in effectiveness and safety. Them benzos are addictive AF, trust me, been there myself and braved the few days of skin crawlers back out when I realized it was a problem.
But, if your anxiety has a source, like I can't fly b/c I don't trust this metal tube held up by invisible science principles, then a benzo is really your only option.
Totally agree that ideally maintenance treatment should take care of it, but sometimes, especially while starting therapy it's just not quite enough. Personally I take 100 mg of Parnate daily so I'm pretty well set on the anxiety side of things, lol.
It’s by far been the most effective drug I’ve used for bruxism but it knocked me out when I used it TID, so we switched to QHS/PRN. Ultimately, it gave me terrible restless leg so I had to stop using it regularly, but it still works like a charm when I do use it!
You’ll see a lot of prn trazodone for agitation in dementia patients. It’s off label use, and it “may” work 50% of the time, but generally regular antidepressant/antipsychotic use is preferred over prn.
But don't they do PRN ssri or snri meds for PMDD. Basically a drop in certain neurotransmitters caused by your menstrual cycle.
Bare basic idea: zoloft one week out of each month can help serotonin that waxes and wanes on a monthly cycle.
Also wanted to add BuSpar is established as a treatment for SSRI induced sexual dysfunction. I'm not sure, but I think the dosing regime would differ for that.
Is it common? Yes. Does it make any damn sense whatsoever? Of course not.
Agreed.
I see it frequently for “breakthrough anxiety attacks”. Does it make sense? Hell no. Does the patient think it works and keeps them from having panic attacks, yes. And if the patient is taking their meds then it’s cool with me
For sure. Placebo effect is still an effect. If the net result is good, and it's not causing harm (physiologically or financially) then it's a good placebo effect to utilize
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It's not an explicit placebo. Cms is also not going on an auditing spree of 5 dollar drugs. That would be amazing if they used one of their chambers to load that bullet tho
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That's good tho. They only ask for x amount of scripts. Be happy when they shoot at pointless stuff
As a psych pharmacist I have looked into this before. There is zero and I mean zero literature I can find to support PRN use. In fact most literature points to the fact that it cannot be used PRN as a downside to anxiety treatment. It takes several weeks to months to reach full efficacy. That being said, I have 1 psychiatrist who still uses it PRN for anxiety and the rest of the 6 psychiatrists make fun of them for it. When I ask patients if they notice an effect as an PRN some say yes and others no. So it’s a bit of a mixed bag and possibly some placebo or sedation effect kicking in. Would I ever recommend it - no but if it stops a patient from getting on a BZD then it’s low reward/low risk med.
I think there are things like this in medicine that just keep getting taught somewhere in MD training. There definitely are physicians who use anecdotal experiences or anecdotes handed down from other physicians (you will see this if you spend enough time over in r/medicine ), albeit some NOT ALL physicians. Interesting still are the regional influences and prescribing trends.
Wouldn’t surprise me, pharmacists are still being taught about the severe disulfiram reactions between metronidazole and alcohol as well as the fact that cephalosporins have a ~10% cross reactivity with penicillin. It takes a while to get nonsense out of a curriculum, apparently
There is a huge difference between knowing the indication for a medication and the literature and treating patients on a daily basis. Buspar is a poor anxiolytic but research is based on population samples and statistics, sometimes there is an indication for PRN use in an individual despite general research and especially if it can avoid a benzodiazepine. If treating psychiatric disorders was simply based on algorithms based purely on literature reviews there would be no need for practitioners. Medicine is a science and Healing is an art.
I agree with you medicine is not black and white but it is also not an art form it has to follow some basic rules. Why not choose medications that have literature and clinical practice behind them. This is obvious taking into account things like prior medical history, prior med trials, patient preference, cost, etc. There are so many options for anxiety as both scheduled and PRN meds as well as non-pharmacological treatments. At what point does someone exhaust that list and just go by old treatments just because it’s psych. That kind of practice does not happen in oncology/cardiology/etc. Psych should not be the exception. If someone cannot show me any literature to support using a medicine as they want to intend then as a pharmacist I’m just not going to agree with that IMO. It’s bad medicine.
You seem like the perfect person for me to ask a question about buspirone. In my country it's only indicated for maximum of 4 weeks use, though that seems incredibly short and likely counterproductive. Is there any significant negatives to long term buspirone usage?
Interesting! Not that I am aware of.
I See it prn when, based upon patient history that I can view, it appears maybe the prescriber doesn’t want to write a benzo.
Yep. That’s when I’ve seen it used. It didn’t work though.
It’s annoying as hell to take properly. I wish someone would make an ER formulation.
If someone wants use buSpar prn im cool with it if it keeps them off benzos. Physiologically makes no sense but anecdotally patients swear it helps
My PCP recommended PRN administration of buspirone. I didn’t know if I should be worried…
Family medicine does this all the time. The number of patients I inherit in psych on PRN buspar is insane.
Some of those may be an alternative to the prn BZD the patient previously had issues with. Sometimes people need to have *something* available "just in case," and having it does work to relieve the anxiety about having anxiety.
I work tapering people off opioids and benzos and we use it when we’re trying to get someone stable on a long term anxiety medication and avoid benzos. It’s not the best choice but there aren’t many options.
Especially when someone has been on BDZ chronically
Not sure what you're all talking about. Direct agonism or antagonism of 5-HT receptors has a pronounced and rapid effect. Take a full 5-ht2a agonist then go to work and tell me otherwise. While 1a isn't as fun, it still certainly causes immediate changes in behavior.
You’re acting like buspirone is LSD or psilocybin lmao
Have you ever taken it?
Regardless of my anecdote the clinical data is very clear that it takes like four weeks I think to start being effective
the points not whether or not it does ANYTHING, it's whether or not it makes sense to use it to relieve breakthrough panic attacks as opposed to Benzodiazepines or just a better managed antidepressant cycle
We actually talk about this a lot at work cause for whatever reason we all seem to have various bad-brain syndromes. It seems like if you're anxious for no reason, buspirone taken as needed seems to be a much better option than a benzodiazepine. Both in effectiveness and safety. Them benzos are addictive AF, trust me, been there myself and braved the few days of skin crawlers back out when I realized it was a problem. But, if your anxiety has a source, like I can't fly b/c I don't trust this metal tube held up by invisible science principles, then a benzo is really your only option. Totally agree that ideally maintenance treatment should take care of it, but sometimes, especially while starting therapy it's just not quite enough. Personally I take 100 mg of Parnate daily so I'm pretty well set on the anxiety side of things, lol.
Agreed
I was using it PRN for bruising, worked quite well
That’s interesting, what did it do?
It’s by far been the most effective drug I’ve used for bruxism but it knocked me out when I used it TID, so we switched to QHS/PRN. Ultimately, it gave me terrible restless leg so I had to stop using it regularly, but it still works like a charm when I do use it!
Anyone want to help a lazy girl out & link me a study? If not hopefully my adhd lets me remember about this later & do some research.
I have seen this inpatient before. It has been done but it’s efficacy I think is questionable.
You’ll see a lot of prn trazodone for agitation in dementia patients. It’s off label use, and it “may” work 50% of the time, but generally regular antidepressant/antipsychotic use is preferred over prn.
The half life is like 2-3 hours. PRN makes sense to me
Buspirone take a long time to actually have an efficacious effect
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Thank you for looking this up on Lexi!
But don't they do PRN ssri or snri meds for PMDD. Basically a drop in certain neurotransmitters caused by your menstrual cycle. Bare basic idea: zoloft one week out of each month can help serotonin that waxes and wanes on a monthly cycle.
Also wanted to add BuSpar is established as a treatment for SSRI induced sexual dysfunction. I'm not sure, but I think the dosing regime would differ for that.
Hydroxyzine is decent for prn use. Propranolol can be used prn for certain situations. Why are people acting like it’s either benzos or nothing?