First line medications for ADHD are stimulants. However, many patients/families either feel uncomfortable with stimulants, or find that stimulants just are not doing the trick for their symptoms. Guanfacine is also commonly added when a patient is struggling with insomnia.
A number of nonstimulants are useful in treating ADHD. This is an introductory look at guanfacine.
A number of nonstimulants are useful in treating ADHD. This is an introductory look at guanfacine.
Pluses
Guanfacine has a different side effect profile from the stimulants. It does not affect appetite or cause insomnia, and it is not habit forming. Because it is nonaddictive, it does not need a special prescription (like stimulants always do), reducing hassle, and it does not pose a danger to others who may have substance abuse problems. Guanfacine does not usually worsen tics, and it is pregnancy class B (although the data are limited).
Generic guanfacine is also the cheapest medication for ADHD. At $4 for a one month's supply at Walmart and other discount pharmacies, the price is difficult to beat.
Guanfacine is thought of as an all day medication. It typically does not wear off late in the day, so patients who use this medication often have better early mornings and bedtimes than those on stimulants.
Generic guanfacine is also the cheapest medication for ADHD. At $4 for a one month's supply at Walmart and other discount pharmacies, the price is difficult to beat.
Guanfacine is thought of as an all day medication. It typically does not wear off late in the day, so patients who use this medication often have better early mornings and bedtimes than those on stimulants.
Minuses
Guanfacine may not have the same side effects as stimulants, but it has its own unique downsides. For one thing, it can take a while to notice an effect. Most patients report it can take anywhere from 2 to 6 weeks for any change in their ADHD to be noticable.
Generic Intuniv (guanfacine ER) contains yellow dye (FDC#6). This may be an issue for yellow dye sensitive patients. A doctor's letter of medical necessity will likely be required to obtain brand name Intuniv.
Guanfacine also can have side effects. Sleepiness/drowsiness/fatigue/sedation
are common at the outset.
Many patients will notice that side effects decrease over the course of about 2-6
weeks. While patients do not need to feel
sedated for the medication to be effective, for some patients this is its only effect.
Patients who have daytime drowsiness can minimize this problem by taking the medication at bed time, although many need to move the dose to the morning to get its full effect.
Guanfacine sometimes can cause low blood pressure, slow heart rate, or even fainting, so patients with heart disease or low blood pressure should consult with their heart doctor to make sure it is safe to take guanfacine. Patients should be careful to stay well hydrated and avoid getting overheated, especially when ill or exercising, to avoid lightheadedness and fainting.
Headaches are also
common and usually do not go away even after several weeks of treatment.
Some patients have reported strange sleep related behaviors on guanfacine: nightmares, waking hallucinations, or middle of the night awakening.
Intuniv vs. Tenex
Tenex is the older, immediate release form of guanfacine. Guanfacine was originally developed as a blood pressure medicine many years ago, so it is unlikely that surprise side effects will surface. Intuniv is the extended release form of guanfacine. Interestingly, both drugs are usually given once a day, though Tenex may be given twice a day if necessary. The main difference between the two formulations is that drug levels are a little more steady and predictable with Intuniv, which could result in different effects and side effects, depending on the patient. Intuniv is newer, and has recently come out as a generic, but it is likely to remain more expensive than generic Tenex for some time.
Intuniv vs. Tenex
Tenex is the older, immediate release form of guanfacine. Guanfacine was originally developed as a blood pressure medicine many years ago, so it is unlikely that surprise side effects will surface. Intuniv is the extended release form of guanfacine. Interestingly, both drugs are usually given once a day, though Tenex may be given twice a day if necessary. The main difference between the two formulations is that drug levels are a little more steady and predictable with Intuniv, which could result in different effects and side effects, depending on the patient. Intuniv is newer, and has recently come out as a generic, but it is likely to remain more expensive than generic Tenex for some time.
Nonstimulants have an important place both as solo and add-on treatment for ADHD. They offer important advantages such as all day control and no addictive potential. However, they are not without side effects. The best way to choose a medication is to educate yourself and to discuss it with your doctor.
This article is part
of a series on nonstimulant medications for ADHD. The other articles in the series are Atomoxetine (Strattera), clonidine, and Bupropion (Wellbutrin).
References:
Intuniv [package insert].Shire US, Inc. Wayne ,
PA
Kollins, S. H.,
F. A. Lopez, B. D. Vince, J. M. Turnbow, K. Farrand, A. Lyne, S. B. Wigal, and
T. Roth. "Psychomotor Functioning and Alertness with Guanfacine Extended
Release in Subjects With Attention-Deficit/Hyperactivity Disorder." Journal of Child and Adolescent
Psychopharmacology 21.2
(2011): 111-20. Print.
Everything ADHD Privacy Policy
No comments:
Post a Comment