Lilliana asked
My daughter is 5 and started Guanfacine 2 mg for ADHD last Thursday. She is extremely irritable and I was called 4x from school... she was sleeping. Her overall personality has changed. Can I just stop the medicine? It is extended release so I can't cut it. Thank you.
Answer
Intuniv (Guanfacine Extended Release) is a non-stimulant add-on or alternative for the treatment of ADHD.
While it can be very effective in treating hyperactivity and inattentiveness, it has a major downside...many become overly fatigued and drowsy while taking it. Due to this, it is often best used as an add on to stimulant therapy (e.g. Adderall) or in those who have more severe ADHD symptoms such as aggression or anxiety.
Intuniv (guanfacine ER) in most situations, should not be discontinued immediately due to the risk of rebound hypertension (elevated blood pressure). The risk of rebound hypertension is smaller than with immediate release versions of guanfacine, but the risk is still there.
In regard to how to discontinue the drug, the manufacturer gives the following recommendation:
"If therapy is to be discontinued, taper the daily dose in decrements of no more than 1 mg every 3—7 days to avoid rebound hypertension; monitor blood pressure and pulse when reducing dose or discontinuing therapy."
Since your daughter has been on the medication for a relatively short amount of time, her doctor may recommend a different method of discontinuation. It is important to speak with her doctor to come up with the best course of therapy for your daughter's specific situation.
As you mentioned, Intuniv (guanfacine ER) cannot be cut. A smaller dose may be prescribed to assist with a taper, or a different drug altogether. There are many different options available to safely discontinue the drug and find an alternative that is effective, without the adverse reactions your daughter is experiencing now.
