Guanfacine for attention deficit hyperactivity disorder in children

Guanfacine is a nonstimulant alpha-adrenergic receptor agonist that may be useful in children with attention deficit hyperactivity disorder (ADHD) who:

  • do not tolerate stimulants or atomoxetine (eg who have significant sleep disturbance that cannot be resolved by adjusting drug timing and dosage)
  • have had an inadequate response to stimulants—guanfacine is used as adjunctive treatment with the stimulant
  • have a comorbid tic disorder (eg Tourette syndrome).

If guanfacine is indicated for ADHD in children 6 years or older, a suitable regimen is:

guanfacine 1 mg orally, at bedtime. Assess the patient’s response to therapy after 1 week to determine the need for dose adjustment. If needed, increase the daily dose by 1 mg no more frequently than every 1 week until an acceptable response is achieved or the maximum daily dose is reached (4 mg in children younger than 13 years; 7 mg in children 13 years or older). See further advice on monitoring and duration of treatment. attention deficit hyperactivity disorder guanfacine