TaperCommunityguanfacine
Guanfacine ER is a selective alpha-2A adrenergic agonist for ADHD (children, adolescents, sometimes adults) and an off-label add-on for hypertension and tics. Non-stimulant, non-controlled. Sedation and rebound hypertension on stopping are the main concerns.
1mg, 2mg, 3mg, 4mg ER tablets
ER tablets: 1mg, 2mg, 3mg, 4mg; IR tablets (Tenex): 1mg, 2mg
Category B
Selective alpha-2A adrenoceptor agonist in the prefrontal cortex — improves working memory and impulse control by strengthening prefrontal connectivity.
Step down 1mg per week. Do not stop abruptly — rebound hypertension is real.
A planned step-down avoids the cardiovascular rebound that abrupt discontinuation can cause.
1-3 days
5-10 days
2-4 weeks
Sleep changes can persist 4-6 weeks
Toxicity
Sedation, hypotension, bradycardia, syncope, dry mouth, abdominal pain. Rebound hypertension on abrupt discontinuation.
Pharmacokinetics
Hepatic via CYP3A4.
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