Guanfacine

Brands

DEA Class;  Rx

Common Brand Names; Intuniv, Tenex

  • Alpha2 Adrenergic Agonists; 
  • ADHD Agents

Oral, central acting alpha-2 adrenergic agonist
Used for hypertension in adults; used for attention deficit hyperactivity disorder (ADHD) in pediatric patients 6 years and older and adult patients
Similar to clonidine but is more selective for alpha-2 adrenergic receptors and longer-acting, which allows for once-daily dosing.

Indicated for the treatment of hypertension.
For the treatment of attention-deficit hyperactivity disorder (ADHD), as monotherapy or as adjunctive therapy to a psychostimulant.
NOTE: Do not substitute immediate-release (IR) and extended-release (ER) products on a mg-per-mg basis; if converting from IR guanfacine, discontinue IR treatment and titrate with the ER product.
For the treatment of Tourette’s syndrome or chronic tic disorders.

Hypersensitivity

  • Xerostomia (10-60%)
  • Somnolence (5-39%)
  • Headache (0.2-26%)
  • Dizziness (2-15%)
  • Constipation (2-16%)
  • Fatigue (2-15%)
  • Abdominal pain (11%)

Extended-release tablets

  • Somnolence (6-38%)
  • Headache (23%)
  • Dizziness (6-16%)
  • Decreased appetite (6-15%)
  • Fatigue (2-14%)
  • Abdominal pain (11%)
  • Hypotension (7%)
  • Asthenia (2-7%)
  • Impotence (0-7%)
  • Lethargy (6%)
  • Dizziness (6%)
  • Irritability (6%)
  • Nausea (3-6%)
  • Decreased appetite (5%)
  • Weakness (1-5%)
  • Insomnia (3-4%)
  • Bradycardia (3%)
  • Palpitations (3%)
  • Confusion (3%)

Avoid abrupt withdrawal (can result in anxiety, nervousness, and rebound hypertension)

May cause hypotension, orthostasis, bradycardia, and syncope, use with caution in history of cerebrovascular disease, recent MI, severe coronary insufficiency, or syncope

Chronic renal/hepatic failure

May cause sedation, especially at start; avoid operating heavy machinery

Skin rash with exfoliation reported

Avoid concomitant use with other CNS depressants (eg, alcohol) as they may potentiate CNS effects

Risk of cardiovascular effects may increase when administered concurrently with antihypertensive medications or drugs that affect heart rate

In post marketing experience, abrupt discontinuation of the extended-release tablets has resulted in clinically significant and persistent rebound hypertension above baseline levels and increases in heart rate; hypertensive encephalopathy reported in association with rebound hypertension with guanfacine

There is pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, during pregnancy

There are no data on presence of guanfacine in human milk or effects on breastfed infant; effects on milk production are also unknown

Adults

3 to 4 mg/day PO (immediate-release); 7 mg/day PO of extended-release tablets (Intuniv) for ADHD.

Geriatric

3 to 4 mg/day PO (immediate-release). Safety and efficacy for ADHD has not been established.

Adolescents

3 to 4 mg/day PO (immediate-release); 7 mg/day PO of extended-release tablets (Intuniv) for ADHD.

Children

6 to 12 years: 4 mg/day PO of extended-release tablets (Intuniv) for ADHD.
4 to 5 years: Safety and efficacy have not been established; however, doses up to 4 mg/day PO (immediate-release) have been used off-label for the treatment of ADHD.
1 to 4 years: Safety and efficacy have not been established.

Infants

Safety and efficacy have not been established.

Neonates

Safety and efficacy have not been established.

Guanfacine hydrochloride

tablet (Tenex)

  • 1mg
  • 2mg
Drugs Generic
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