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Attention deficit hyperactivity disorder (ADHD): avoid guanfacine

In children diagnosed with attention deficit hyperactivity disorder (ADHD), guanfacine has no proven efficacy in improving family and social relationships. On the other hand, it has frequent, sometimes severe, adverse effects. In practice, it is best to avoid guanfacine.

The diagnosis of attention deficit hyperactivity disorder in children is based on non-specific behavioural symptoms: inattentiveness, hyperactivity and impulsiveness. The disruptive impact on family and social relationships and on academic performance requires psychological, educational and sometimes social support, which is helpful for a majority of children.

In exceptional cases, when the child's behaviour gives serious cause for concern, methylphenidate drug therapy may be offered. But it is ineffective in about 25% of these children, and has numerous, sometimes severe, adverse effects, especially neuropsychological and cardiovascular disorders. Pulmonary arterial hypertension, valvulopathy and sudden death have also been reported.

Guanfacine has been authorised for these children if so-called psychostimulant drugs (especially methylphenidate) fail. Analysis of the available clinical trial data shows that there is no evidence that guanfacine, alone or in combination with amphetamines, has any benefit on family and social relationships.

Conversely, guanfacine has many adverse effects, including excessive drowsiness, which can give rise to accidents and difficulties at school, and severe cardiovascular disorders.

In practice, it is best to avoid guanfacine.

©Prescrire 1 October 2017

"Guanfacine (Intuniv°) and attention deficit hyperactivity disorder. Excessive drowsiness and serious cardiovascular harms" Prescrire Int 2017; 26 (186): 233-236. (Pdf, subscribers only).

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See also:

Methylphenidate: adverse
cardiovascular effects
(Juin 2015)

Methylphenidate: abuse
and addiction
(October 2012)

Methylphenidate and
hyperactive children:
stunted growth
(October 2011)

Hyperactivity in children:
risk of hallucinations
with methylphenidate
(September 2006)

Hyperactivity in children
with attention deficit disorder:
methylphenidate only
as a last resort
(June 2006)