Happy new year! Sorry for the lag in posting. The holidays hit, which was followed by a busy grant submission cycle so I was unable to get back to blogging! As part of my ongoing family friendly handouts for ADHD and behavior, I have the fourth installment with Guanfacine, an alpha-2-agonist medication.
This medication is sometimes used for the treatment of ADHD as a second line agent. It does not have FDA approval for use in children under 6 years of age. However, I have used this medication for younger patients who have a combination of sleep problems, impulse control issues and aggression. I often tell parents that the first effect is helping the child sleep and after 2-3 weeks of giving the medicine every day, we see the effects on impulse and aggression. Unlike stimulant medications, the effect on impulse control is not as quick. These medications should always be monitored in children and never stopped suddenly. The medicine is thought to enhance certain receptors in the brain, especially those that can affect impulse control, working memory and focus. However, these receptors are also found in other parts of the body (such as blood vessels and the heart). Clonidine, is another medicine in this class and works similarly to Guanfacine, but attaches to these receptors more widely throughout the body. This can result in more side effects than guanfacine, which tends to choose to bind (or be attracted to) the receptors in the brain only.
I personally choose to start this medicine at bedtime since medicines in this class can cause drowsiness/sedation. However, you can dose this medication in the morning and sometimes it is given twice a day.
Sometimes these medicines are prescribed along with a stimulant medication.
A word of caution, if your child ever experiences side effects listed on the handout, do NOT stop the medicine abruptly. Talk to your child’s doctor to safely taper the medicine as it can cause rebound/increases in blood pressure or heart rate.
Remember, to talk with your child’s doctor about this medicine or any of the medicines highlighted on my blog. Your doctor will talk with you about when a medicine is indicated, and provide their thought process when thinking about which medicine to start with.
Remember to share this information with your child, with partners, with educators and other providers. And remember to consider keeping a Medication Log when starting or changing doses to help your child’s doctor understand whether a medicine is doing what is supposed to be doing.
As with any of my handouts, please feel free to use and share. I would love to get feedback on this or any other handout on my blog!
ALSO, advice given on my blog about medications is NOT A SUBSTITUTE FOR MEDICAL ADVICE by your child’s physician. Always talk to your child’s doctor directly about their thoughts on the appropriate medicine and other treatments for your child’s ADHD. Medicine is just one type of treatments available.