A 29-year-old woman with generalized anxiety disorder is reluctant to take a benzodiazepine because a friend became dependent on one. Her psychiatrist prescribes buspirone instead. Which statement about this drug is correct?

• A It acts as an allosteric modulator at the benzodiazepine binding site on GABA-A receptors
• B It produces meaningful anxiolytic benefit within a few hours of the first dose
• C It has marked cross-tolerance with alcohol and potentiates alcohol-induced sedation
• D It is a partial agonist at presynaptic and postsynaptic 5-HT1A receptors, with anxiolytic effect requiring 1 to 2 weeks ✓

Explanation

Buspirone is a partial agonist at the 5-HT1A receptor. Like SSRIs, its anxiolytic effect is delayed by 1 to 2 weeks, which is why it cannot replace a benzodiazepine for immediate relief. It causes little sedation, has no potential for dependence, and does not show cross-tolerance with alcohol, making option C false. It binds to neither the benzodiazepine nor the barbiturate site on the GABA-A receptor, so it will not reverse benzodiazepine withdrawal.

Reference: Katzung Basic and Clinical Pharmacology, 16th ed.

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