Guanfacine

Guanfacine Brand Names- Intuniv | Tenex

What is Guanfacine

Guanfacine is an oral, centrally-acting alpha-2 adrenergic receptor agonist. It used alone or in combination with other drugs for the treatment of hypertension.

For the treatment of hypertension, it works by producing a decrease in sympathetic outflow, resulting in a reduction in peripheral vascular resistance, renal vascular resistance, heart rate, and blood pressure.

Guanfacine is similar to clonidine but is more selective for alpha-2 adrenergic receptors and longer-acting, which allows for once-daily dosing and may delay the risk of rebound hypertension with abrupt discontinuation.

Extended-release guanfacine is used in the treatment of attention deficit hyperactivity disorder (ADHD); the drug targets ADHD symptoms through central alpha-2 adrenergic receptor activity in the prefrontal cortex.

Guanfacine may be advantageous for treating ADHD in children with comorbid tics, since the use of stimulants in such patients may exacerbate the tic condition.

Guanfacine is used ‘off-label’ for Tourette’s syndrome and chronic tic disorder. The American Academy of Neurology practice guideline states that guanfacine is probably more likely than placebo to reduce tic severity in patients with Tourette’s syndrome or chronic tic disorders, and for those with comorbid ADHD, the drug may provide benefits for both conditions

Indications

  • attention-deficit hyperactivity disorder (ADHD)
  • hypertension
  • Tourette’s syndrome

Side Effects

  1. abdominal pain
  2. agitation
  3. alopecia
  4. amnesia
  5. anxiety
  6. arrhythmia exacerbation
  7. arthralgia
  8. asthenia
  9. AV block
  10. blurred vision
  11. bradycardia
  12. bronchospasm
  13. chest pain (unspecified)
  14. confusion
  15. conjunctivitis
  16. constipation
  17. depression
  18. diarrhea
  19. dizziness
  20. drowsiness
  21. dysgeusia
  22. dyspepsia
  23. dysphagia
  24. dyspnea
  25. edema
  26. elevated hepatic enzymes
  27. emotional lability
  28. encephalopathy
  29. exfoliative dermatitis
  30. fatigue
  31. hallucinations
  32. headache
  33. heart failure
  34. hyperhidrosis
  35. hypertension
  36. hypotension
  37. impotence (erectile dysfunction)
  38. increased urinary frequency
  39. insomnia
  40. iritis
  41. irritability
  42. lethargy
  43. libido decrease
  44. malaise
  45. muscle cramps
  46. myalgia
  47. myocardial infarction
  48. nausea
  49. nightmares
  50. nocturia
  51. orthostatic hypotension
  52. pallor
  53. palpitations
  54. paresis
  55. paresthesias
  56. pruritus
  57. purpura
  58. rash
  59. renal failure (unspecified)
  60. rhinitis
  61. seizures
  62. sinus tachycardia
  63. stroke
  64. syncope
  65. tinnitus
  66. tremor
  67. urinary incontinence
  68. vertigo
  69. vomiting
  70. weakness
  71. weight gain
  72. wheezing
  73. withdrawal
  74. xerostomia

Monitoring Parameters

  • blood pressure
  • heart rate
  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • acute myocardial infarction
  • AV block
  • bradycardia
  • breast-feeding
  • cardiac disease
  • cerebrovascular disease
  • children
  • coronary artery disease
  • dehydration
  • driving or operating machinery
  • ethanol ingestion
  • geriatric
  • hepatic disease
  • hypotension
  • infants
  • orthostatic hypotension
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • syncope

Interactions

  • Acebutolol
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetazolamide
  • Aldesleukin, IL-2
  • Alemtuzumab
  • Alprazolam
  • Alprostadil
  • Amifostine
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Celecoxib
  • Amobarbital
  • Amoxapine
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamines
  • Amyl Nitrite
  • Apalutamide
  • Apomorphine
  • Apraclonidine
  • Aprepitant, Fosaprepitant
  • Aripiprazole
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atenolol
  • Atenolol; Chlorthalidone
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Baclofen
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Bendroflumethiazide; Nadolol
  • Benzodiazepines
  • Beta-blockers
  • Betaxolol
  • Bexarotene
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Boceprevir
  • Bortezomib
  • Bosentan
  • Brexpiprazole
  • Brimonidine; Timolol
  • Bupropion
  • Bupropion; Naltrexone
  • Butabarbital
  • Cabergoline
  • Cannabidiol
  • Carbamazepine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbonic anhydrase inhibitors
  • Cariprazine
  • Carteolol
  • Carvedilol
  • Celecoxib
  • Cenobamate
  • Ceritinib
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Chloramphenicol
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorpromazine
  • Ciprofloxacin
  • Clarithromycin
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Co-Enzyme Q10, Ubiquinone
  • Cobicistat
  • Cocaine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Conivaptan
  • Crizotinib
  • Cyclosporine
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Deferasirox
  • Delavirdine
  • Desipramine
  • Dexamethasone
  • Dexmethylphenidate
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Diazoxide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diltiazem
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dorzolamide; Timolol
  • Doxepin
  • Dronedarone
  • Duloxetine
  • Duvelisib
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix
  • Elagolix; Estradiol; Norethindrone acetate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Enflurane
  • Enzalutamide
  • Epoprostenol
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Esketamine
  • Eslicarbazepine
  • Esmolol
  • Esomeprazole; Naproxen
  • Estazolam
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Ethanol
  • Etodolac
  • Etomidate
  • Etravirine
  • Famotidine; Ibuprofen
  • Fedratinib
  • Fenfluramine
  • Fenoprofen
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Fluconazole
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
  • Flurbiprofen
  • Fluvoxamine
  • Fosamprenavir
  • Fosphenytoin
  • Fospropofol
  • Gabapentin
  • General anesthetics
  • grapefruit juice
  • Haloperidol
  • Halothane
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone; Ibuprofen
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Idelalisib
  • Iloperidone
  • Iloprost
  • Imatinib
  • Imipramine
  • Indinavir
  • Indomethacin
  • Intravenous Lipid Emulsions
  • Isavuconazonium
  • Isoflurane
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isosorbide Dinitrate, ISDN
  • Isosorbide Mononitrate
  • Itraconazole
  • Ketamine
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Labetalol
  • Lansoprazole; Naproxen
  • Lasmiditan
  • Lemborexant
  • Letermovir
  • Levobetaxolol
  • Levobunolol
  • Levocetirizine
  • Levodopa
  • Lofexidine
  • Lopinavir; Ritonavir
  • Lorazepam
  • Lorlatinib
  • Lovastatin; Niacin
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Lumateperone
  • Lurasidone
  • Maprotiline
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Meperidine; Promethazine
  • Mephobarbital
  • Mesoridazine
  • Mestranol; Norethindrone
  • Methazolamide
  • Methylphenidate
  • Metoprolol
  • Midazolam
  • Milrinone
  • Mitotane
  • Monoamine oxidase inhibitors
  • Nabilone
  • Nabumetone
  • Nadolol
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nebivolol
  • Nebivolol; Valsartan
  • Nefazodone
  • Nelfinavir
  • Nesiritide, BNP
  • Netupitant, Fosnetupitant; Palonosetron
  • Nevirapine
  • Niacin, Niacinamide
  • Niacin; Simvastatin
  • Nilotinib
  • Nitrates
  • Nitroglycerin
  • Nitroprusside
  • Nonsteroidal antiinflammatory drugs
  • Nortriptyline
  • Olanzapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Opiate Agonists
  • Oxaprozin
  • Oxazepam
  • Oxymetazoline
  • Paliperidone
  • Penbutolol
  • Pentobarbital
  • Pentoxifylline
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenobarbital
  • Phenothiazines
  • Phenylephrine; Promethazine
  • Phenytoin
  • Pindolol
  • Piroxicam
  • Posaconazole
  • Prazosin
  • Pregabalin
  • Primidone
  • Procainamide
  • Procaine
  • Prochlorperazine
  • Promethazine
  • Propofol
  • Propranolol
  • Protriptyline
  • Quazepam
  • Quinidine
  • Quinine
  • Rasagiline
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Risperidone
  • Ritonavir
  • Rofecoxib
  • Saquinavir
  • Secobarbital
  • Sevoflurane
  • Silodosin
  • Sotalol
  • St. John’s Wort, Hypericum perforatum
  • Sulindac
  • Telaprevir
  • Telithromycin
  • Temazepam
  • Tetrabenazine
  • Tetracaine
  • Thiethylperazine
  • Thioridazine
  • Thiothixene
  • Timolol
  • Tipranavir
  • Tizanidine
  • Tolmetin
  • Trandolapril; Verapamil
  • Trazodone
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Tucatinib
  • Valdecoxib
  • Verapamil
  • Voriconazole
  • Yohimbine
  • Ziprasidone