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Clinician’s Corner: Short term treatment of anxiety

Most prescribers are not comfortable with long term benzodiazepine use today in family practice.  We live in a very “anxious” society and our patients are frequently looking for help reducing anxiety.  This column focuses on some of the more common alternatives for short term treatment of anxiety.

Buspirone (Buspar®)  (FDA approved:1986)

COMMON USES of Buspirone

  • Augment the effects of SSRI
  • Improves SSRI induced sexual dysfunction.
  • Long term anxiety control

Worth knowing about buspirone

  • Not a Benzodiazepine, no anticonvulsant effect, no muscle relaxant effect.
  • Food does affect absorption, so take it at consistent times. May take with food to avoid GI upset.
  • No sedation. Slight chance of drowsiness.
  • No dependence
  • Not useful on a PRN basis. Does not work quickly to provide relief.  May take as long as
  • 21 days to see maximum benefit

Clonidine (Catapres®)                 (FDA approved:1974)  

Clonidine is effective in reducing physical symptoms but NOT psychic symptoms such as anxiety worry and apprehension.

Worth knowing about clonidine

  • Useful for social phobias (fear of public speaking) – limited use in Generalized Anxiety Disorder.
  • Decreases nervous and stimulating activity.
  • Used for opioid detoxification to control the sympathetic symptoms of withdrawal, such as yawning, pounding heartbeats, watery eyes, feeling cold (piloerection), stomach pain, feeling sick, body aches, muscle tightness, or trouble sleeping

Propranolol (Inderal®)         (FDA approved:1967)

Worth knowing about beta-blockers

  • Beta blockers are not recommended as first line therapy for Generalized Anxiety Disorder but in conjunction with Benzodiazepines, Buspirone or antidepressants, when somatic symptoms persist.
  • Blocks the “fight or flight” response, such as racing heart, cold/clammy hands, increased respiration and sweating,
  • Remember: beta blockers may exacerbate depression.

Hydroxyzine Hydrochloride and Pamoate:

Hydroxyzine Hydrochloride= tablets= Atarax® 10,25,50 and 100mg. syrup:10mg/tsp (1956), were marketed by Roerig

Hydroxyzine pamoate = capsules= Vistaril® 25,50, 100mg.  The injection as available in 1957, the capsules were approved and marketed by Pfizer in 1968.

Worth knowing about hydroxyzine:

  • Efficacy: Not proven to be effective past four
  • Causes much drowsiness and dry mouth. Avoid alcohol
  • Avoid especially during first and second trimester of pregnancy.
  • There is really no difference between hydroxyzine hydrochloride and hydroxyzine pamoate.

Your Thompson Pharmacist is a great resource in helping your physician help you with the excessive anxiety.  We can help you manage your side effects with your prescription medications.  Our goal is to help you feel your best so you can live life to the fullest.  Go Ahead and ASK…. At Thompson Pharmacy it’s All for YOU!!