In Collaboration With

THERAPEUTICS

Brands

• Intuniv (pending approval)
• Tenex
• see index for additional brand names

Generic?

• Yes (not for guanfacine ER)

Class

• Centrally acting alpha 2A agonist; antihypertensive

Commonly Prescribed For

• (bold for FDA approved)
• Hypertension
• Attention deficit hyperactivity disorder (ADHD) in children ages 6­17 (Intuniv, pending approval)
• Oppositional defiant disorder
• Pervasive developmental disorders
• Motor tics
• Tourette's syndrome

How The Drug Works

• For hypertension, stimulates alpha 2A adrenergic receptors in the brain stem, reducing sympathetic outflow from the CNS and decreasing peripheral resistance, renal vascular resistance, heart rate, and blood pressure
• For ADHD, theoretically has central actions on postsynaptic alpha 2A receptors in the prefrontal cortex

How Long Until It Works

• For ADHD, can take a few weeks to see maximum therapeutic benefits
• Blood pressure may be lowered 30­60 minutes after first dose; greatest reduction seen after 2­4 hours
• May take several weeks to control blood pressure adequately

If It Works

• The goal of treatment of ADHD is reduction of symptoms of inattentiveness, motor hyperactivity, and/or impulsiveness that disrupt social, school, and/or occupational functioning
• Continue treatment until all symptoms are under control or improvement is stable and then continue treatment indefinitely as long as improvement persists
• Reevaluate the need for treatment periodically
• Treatment for ADHD begun in childhood may need to be continued into adolescence and adulthood if continued benefit is documented

If It Doesn’t Work

• Consider adjusting dose or switching to another agent
• Consider behavioral therapy
• Consider the presence of noncompliance and counsel patient and parents
• Consider evaluation for another diagnosis or for a comorbid condition (e.g., bipolar disorder, substance abuse, medical illness, etc.)

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Best to attempt another monotherapy prior to augmenting for ADHD
• Possibly combination with stimulants (with caution as benefits of combination poorly documented)
• Combinations for ADHD should be for the expert, while monitoring the patient closely, and when other treatment options have failed
• Chlorthalidone, thyazide-type diuretics, and furosemide for hypertension

Tests

• Blood pressure should be checked regularly during treatment