Guanfacine and Guanfacine ER (Intuniv): Uses and Evidence in Mental Health Disorders
Guanfacine and its extended-release formulation, Guanfacine ER (Intuniv), are medications primarily used in the treatment of attention deficit hyperactivity disorder (ADHD). However, their use extends to several off-label applications in mental health, including anger and intermittent explosive disorder (IED), disruptive mood dysregulation disorder (DMDD), and cognitive symptoms associated with Long COVID.
Guanfacine generally has fewer and less severe side effects compared to stimulants. It typically does not cause significant appetite loss, extreme irritability, sleeplessness, heightened anxiety, or tics, and may actually help with irritability, anxiety, and tics. However, at higher doses or when the dosage is increased too quickly, it can lead to a drop in blood pressure, which might cause dizziness, particularly when getting up rapidly from sitting or lying down. This is more likely to affect individuals with consistently low blood pressure or orthostatic hypotension, often seen in those with POTS syndrome. To manage this, it's advisable to monitor blood pressure regularly when increasing the dose, using a reliable blood pressure monitor such as the one available on Amazon.
Percentage of Patients Benefiting
Clinical trials and studies indicate that approximately 60-70% of patients with ADHD experience significant improvement in symptoms when treated with Guanfacine ER. For off-label uses, the response rates can vary, with some studies showing a positive impact on mood stability and reduction in aggression.
Dosing
Children (6-12 years): The typical starting dose is 1 mg taken once daily. The dose may be increased by 1 mg per week depending on the patient's response and tolerability, up to a maximum of 4 mg per day.
Adolescents (13-17 years) and Adults: Start with 1 mg daily; this may be gradually increased to a maximum of 7 mg once daily, based on response and side effects.
Best Time to Take It
Guanfacine ER should be taken once daily, either in the morning or evening. Taking it at the same time each day helps maintain an even level of medication in the body. It can be taken with or without food but should be taken the same way consistently.
Do not crush, cut, or chew the tablets, as they are designed for extended release.
Potential Side Effects
Common side effects include:
Sleepiness or sedation
Headache
Fatigue
Abdominal pain
Dizziness
These side effects are generally mild to moderate and often decrease with continued use of the medication.
Potential Contraindications
Guanfacine should be used with caution in patients with:
Low blood pressure and/or frequent episodes of syncope (fainting)
A history of heart disease, slow heart rate, or low blood pressure
Kidney or liver impairment
A history of depression or suicidal thoughts It is important to discuss all health conditions with a healthcare provider before starting Guanfacine.
FDA Approval Information
Guanfacine ER (Intuniv) is approved by the FDA for the treatment of ADHD in children and adolescents aged 6 to 17 years. It is not FDA approved for use in adults with ADHD, but is beneficial and therefore used off-label.
Off-Label Benefits Backed by Research
Research supports the use of Guanfacine in treating additional conditions beyond ADHD:
Anger and IED: Studies suggest Guanfacine can reduce episodes of extreme emotional outbursts and aggression.
DMDD: Guanfacine may help in managing severe mood swings, chronic irritability, and anger in children with DMDD.
Brain Fog from Long COVID: Preliminary evidence indicates that Guanfacine may improve attention and executive function impairments associated with Long COVID.
