buspirone (buspar) and modafinil (provigil)?

[innaminute]

My psychiatrist has just placed me on buspar to handle my anxiety. I'm currently taking 200mg Provigil every morning.

My dosage schedule for buspar is as follows:

1/2 of a 15mg tablet in the morning and 1/2 of a 15mg tablet at night for one week.

Then, 15mg in the morning and 15mg at night. I see him again in a couple of weeks to report back.

He said the only interaction is that the Proviigil may cause the buspar to metabolize a little differently, and explained that it may be like I was taking less than the mg dosage. (Meaning 7.5mg may be a bit lower than 7.5 on effectiveness... and 15mg may really be a bit lower than 15mg on effectiveness...)

Anyway, me being me, went and looked at a drug interaction site and found the following:

Moderate Interaction:

MONITOR: Coadministration with modafinil (the racemate) or armodafinil (the R-enantiomer) may decrease the plasma concentrations of drugs that are substrates of the CYP450 3A4 isoenzyme. Modafinil and armodafinil are modest inducers of CYP450 3A4, and pharmacokinetic studies suggest that their effects may be primarily intestinal rather than hepatic. Thus, clinically significant interactions would most likely be expected with drugs that have low oral bioavailability due to significant intestinal CYP450 3A4-mediated first-pass metabolism (e.g., buspirone, cyclosporine, lovastatin, midazolam, saquinavir, simvastatin, sirolimus, tacrolimus, triazolam, calcium channel blockers). Chronic administration of 250 mg doses of armodafinil has been shown to reduce midazolam systemic exposure (AUC) by 32% and 17% after single oral (5 mg) and intravenous (2 mg) doses, respectively. Similar reductions in plasma concentrations were also observed for cyclosporine, ethinyl estradiol, and triazolam during coadministration of modafinil.

MANAGEMENT: Pharmacologic response to these drugs may be altered and should be monitored more closely whenever modafinil or armodafinil is added to or withdrawn from therapy. Dosage adjustments may be required if an interaction is suspected.

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Can ANYONE explain what that means?

I'm going to email my primary care physician and ask him. I just like to know what I'm putting in my body and how it all works together. I'm a bit of a worrywart... Hence the anxiety meds being added into the combo. LOL!

Thanks!

[muldoon]

It means the Provigil might make the Buspar less effective. But, Buspar has been an absolutely worthless medication to begin with (I'm biased), but if it works for you, but "not quite enough", your doc will just raise the Buspar dose to achieve higher blood concentrations.

Some drugs have low bioavailability because a good portion of it is destroyed by the liver in the first-pass metabolism. So if you take a 15mg Buspar, you may only be getting 8 mg or so that actually gets into your bloodstream and can carry out what little therapeutic effect it has to begin with.

If you have mild anxiety, Buspar may get the job done. Anything over that....don't hold your breath.

[innaminute]

Awesome, thanks.

Yeah, my anxiety is pretty mild. I've been on the stuff at the low dose for about 4 1/2 days and I think I'm starting to notice a mild difference. Not a huge difference, but a mild one.

Thanks again!

[ADDMagnet]

I just started Buspar recently but I'm also weaning off Effexor so I'll have a better idea of how it works once I'm totally off the Effexor. My daughter takes Buspar and she loves it. She had been on Effexor and later Cymbalta, but the Buspar works best for her. I know several others who take Buspar and are pleased with it.

I do know that Buspar works especially for Generalized Anxiety Disorder, which is what my daughter and I both have. It is not for all types of anxiety.