Guanfacine for Treatment of Attention-Deficit Hyperactivity Disorder in Boys

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Abstract
The use of guanfacine hydrochloride (Tenex), a long-acting alpha2 agonist with a more favorable side effect profile relative to clonidine, was examined in boys with ADHD. In this prospective, open-label, non-blinded trial, guanfacine was prescribed to fifteen boys, aged 7 to 17 years old (mean 13.3 years) for 5-10 weeks (mean 8 weeks). Thirteen of the boys were on guanfacine monotherapy, while two were on a single adjunctive agent (with the dose of the latter unchanged during the trial). Rating scales were completed before the start of the guanfacine trial and at 4 to 8 weeks after the dose was stabilized. In general, the guanfacine appeared to be effective in reducing the target symptoms, with minimal side effects. The dose of guanfacine ranged from 0.5 mg to 3 mg daily (with a mode of 0.5 mg bid, and a mean of 1.27 mg daily). In the 13 subjects who completed the trial, the mean decrease in the Conners Parent-Teacher Scale (Short Form) was 11.1 points (t = 7.18, p < 0.0001), while the mean decrease in the Edelbrock CAP inattention subscale was 4.85 (t = 5.94, p < 0.0001) and in the overactivity subscale 3.23 (t = 5.93, p < 0.0001). Two of the patients discontinued the medication, one due to clinical ineffectiveness and one due to apparent overactivation. The findings suggest that guanfacine may be a useful agent in the management of a number of the core features of ADHD. Further studies with a double-blinded placebo-controlled design appear indicated.

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