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Attention Deficit Hyperactivity Disorder
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Margaret J.J. Thompson, Anan El Masry, Samuele Cortese, Wai Chen
Guanfacine is an adrenergic alpha receptor agonist originally developed for treating high blood pressure. It works by influencing the receptors in the brain that strengthen working memory and by reducing distractibility and improving attention and impulse control.
Drug-Induced Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Rull Gurvinder, D. Lobo Melvin
Amphetamines are used to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. They lead to increases in BP similar to those seen with cocaine. In children, increases in only the diastolic BP of 3.9 mmHg have been reported, whereas in adults increases in both systolic and diastolic BP have been seen (3.5 and 2.4 mmHg, respectively) (49). The European Child and Adolescent Psychiatry Guidelines recommend using lowest possible doses, use of drug holidays and also consideration of behavioural therapies as an alternative to medication. Guanfacine, an α-2 agonist, is also used in ADHD, and may help counter the BP elevation.
Psychiatric Treatment Approaches for Pediatric Pain
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
Guanfacine, another central α-2 agonist, is used increasingly in the management of externalizing behaviors in youth, and carries less risk of hypotension and sedation. Guanfacine is approved for ADHD and is longer acting than clonidine with a more modest effect on lowering blood pressure. Although its half-life approaches 20 hours, it also comes in a slightly longer acting formulation, which may be less sedating. Similar to clonidine, it also is helpful for addressing neurophysiologic reactivity in patients with sensory sensitivities or tic disorders. Although clinical studies are lacking, studies have revealed potential benefits of guanfacine on animal models of neuropathic pain (Sabetkasaie, Vala, Khansefid, Hosseini, & Sadat Ladgevardi, 2004).
Current and emerging pharmacotherapeutic strategies for Tourette syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Despite the evidence that the effectiveness of clonidine as anti-tic agent is inferior to antidopaminergic medications such as aripiprazole [32], its relatively safer adverse effect profile makes it a widely prescribed medication, especially in young patients with TS and co-morbid attention-deficit and hyperactivity disorder [28]. The currently available evidence in favor of the efficacy of guanfacine, which was licensed in Europe a few years after North America, is less robust. Therefore, in the AAN guidelines guanfacine is recommended with a lower confidence in its evidence, compared to clonidine [28]. Despite preliminary evidence that clonidine might be more effective in suppressing tics than guanfacine, which, in turn, might be less sedating, to date there has been no trial directly comparing the two alpha-2 agonists [15].
Comment on “Pediatric guanfacine exposures reported to the National Poison Data System, 2000–2016”
Published in Clinical Toxicology, 2021
M. Harrison Snyder, Jennifer A. Ross, Saumitra V. Rege, Christopher P. Holstege
We recently reviewed the article by Winograd et al. [1] that focused on pediatric exposures to guanfacine. In 2009 guanfacine was approved by the FDA for treatment of ADHD in children 6 years of age and older [1]. However, the use of guanfacine in the less than 6 year age group for ADHD is increasing [2–4]. Poison center consultations regarding guanfacine exposures in children have also increased. McGrath et al. noted 870 pediatric cases from 1993 to 1999, of which 478 (54.9%) were in children less than 6 years old; exposure numbers were noted to increase during the 7-year time period [4]. In the article by Winograd et al., 10,927 cases of pediatric guanfacine exposures were reported to the National Poison Data System (NPDS) between 2000-2016, of which 4662 (42.7%) were in the 0–5 year age group [1]. Given this increase in both prescriptions and consultations following exposure, a discussion of the optimal management is pertinent.
Pharmacotherapy of Down syndrome
Published in Expert Opinion on Pharmacotherapy, 2018
Michelle L. Palumbo, Christopher J. McDougle
For the pharmacotherapy of ADHD, first-line treatment in typically developing patients is psychostimulants such as methylphenidate and mixed amphetamine salts. Children with developmental and intellectual disabilities, however, often respond less favorably to psychostimulants and experience more side effects. To date, there is no published data regarding the use of psychostimulants to treat comorbid ADHD in patients with DS. Based on our clinical experience, patients with DS respond more favorably and experience fewer side effects with non-stimulant medications, such as guanfacine, which tends to be our agent of first choice. We typically begin guanfacine at a dosage of 0.5 mg each morning and increase the dosage by 0.5 mg every week, given in the morning and at 3–4 pm in the afternoon. If the patient improves, they usually do so at a dosage of 0.5–1.5 mg twice daily. As described earlier, it is important to monitor the patient for the onset or exacerbation of constipation when using guanfacine.