What is guanfacine used for?

What Is Guanfacine Used For?

Guanfacine is a prescription medicine that acts on specific receptors in the brain to help regulate attention, impulse control, and blood pressure. It belongs to a class of drugs called centrally acting α₂-adrenergic agonists. While first approved for treating high blood pressure, guanfacine is now most widely used (and studied) for attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. Below is an overview of its main uses, how it works, dosing considerations, common side effects, and important warnings.

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Main Uses of Guanfacine

1. Attention-Deficit/Hyperactivity Disorder (ADHD)

   • FDA-Approved:
     • Guanfacine extended-release (brand name Intuniv®) is approved as monotherapy or as an add-on to stimulant medications (e.g., methylphenidate, amphetamines).
     • Scahill et al. (2001) conducted a placebo-controlled pilot study showing significant reduction in ADHD symptoms, particularly hyperactivity and impulsivity, in children and teens.
   • Benefits:
     • Improved focus and reduced impulsiveness
     • Fewer mood swings
     • Can be used when stimulant side effects (insomnia, appetite loss) are problematic

2. High Blood Pressure (Hypertension)

   • FDA-Approved:
     • Immediate-release guanfacine (brand name Tenex®) lowers blood pressure by reducing nerve signals that cause blood vessels to tighten.
   • Benefits:
     • May be chosen when other blood pressure medicines aren’t well tolerated
     • Often used in combination with diuretics or beta-blockers

3. Off-Label Uses

   • Tic Disorders (including Tourette Syndrome)
     • May reduce severity and frequency of motor and vocal tics
     • Often preferred when stimulants worsen tics
   • Sleep Disturbance
     • Can help with sleep initiation in ADHD, particularly when insomnia is stimulated-induced
   • Behavioral Dysregulation & Aggression
     • Sometimes used in autism spectrum disorder or oppositional defiant disorder for mood stabilization
   • Post-Traumatic Stress Disorder (PTSD)
     • Limited studies suggest relief of hyperarousal symptoms (e.g., startle response, irritability)

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How Guanfacine Works

• Mechanism of Action
  • Stimulates α₂A-adrenergic receptors in the prefrontal cortex of the brain
  • Enhances “top-down” regulation of attention, working memory, and impulse control
  • Decreases sympathetic nerve outflow, lowering heart rate and blood pressure

• Pharmacokinetics
  • Well absorbed (80–90%) after oral dosing
  • Peak levels:
  – Immediate-release: 1–4 hours
  – Extended-release: 5–7 hours
  • Elimination half-life: 17 hours (extended-release), allowing once-daily dosing

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Dosage & Administration

Formulation	Typical Starting Dose	Maximum Dose	Dosing Schedule
Immediate-Release	1 mg once daily (morning or bedtime)	3 mg/day (divided doses)	Twice or thrice daily
Extended-Release	1 mg once daily (morning)	4 mg/day	Once daily, morning

• Titration
  • Increase dose in 1 mg increments weekly
  • Monitor blood pressure and heart rate at each step
• Missed Dose
  • Take as soon as remembered unless it’s within 8 hours of next dose; do not double up

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Common Side Effects

Most side effects are mild to moderate and often improve after a few weeks of use:

• Drowsiness or sedation
• Fatigue or low energy
• Dry mouth
• Headache
• Dizziness (especially upon standing)
• Abdominal pain, nausea
• Constipation

If side effects become bothersome or persist beyond 2–4 weeks, speak with your doctor about dose adjustment or alternative therapies.

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Warnings & Precautions

• Blood Pressure & Heart Rate
  • Can cause hypotension (low blood pressure) and bradycardia (slow heart rate)
  • Monitor vital signs regularly, especially when starting or increasing dose

• Rebound Hypertension
  • Abrupt discontinuation may lead to rapid increase in blood pressure and heart rate
  • Taper off gradually over at least 1–2 weeks under medical supervision

• Sedation & Dizziness
  • Avoid driving or operating machinery until you know how guanfacine affects you

• Drug Interactions
  • Additive blood pressure lowering with other antihypertensives, alcohol
  • Caution when used with CNS depressants (benzodiazepines, opioids)

• Special Populations
  • Children: Extended-release form approved down to age 6 for ADHD
  • Older Adults: May be more sensitive to hypotensive effects; start at lower doses
  • Pregnancy & Breastfeeding: Limited data; weigh benefits vs. risks

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Monitoring & Follow-Up

• Initial Evaluation
  • Baseline blood pressure and heart rate
  • ADHD symptom rating scales (for ADHD use)

• Ongoing
  • Check blood pressure/heart rate: every 1–2 weeks during titration, then every 3–6 months
  • Monitor growth (height/weight) in children
  • Reassess ADHD symptoms and side effects regularly

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When to Seek Medical Help

• Signs of severe low blood pressure (dizziness, fainting)
• Very slow heart rate (below 50 bpm) with symptoms (weakness, shortness of breath)
• Allergic reactions (rash, itching, swelling)
• Any sudden or severe side effect

For any potentially life-threatening or serious concerns, always speak to a doctor or visit your nearest emergency department.

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Next Steps & Resources

If you’re wondering whether your child or you might benefit from guanfacine for ADHD or other symptoms, you may consider a free, online symptom check for additional guidance before seeing your healthcare provider.

Remember: This information is meant to supplement—not replace—professional medical advice. Always consult your doctor or pharmacist before starting, changing, or stopping any medication.