Guanfacine extended release in the treatment of attention deficit hyperactivity disorder in children and adolescents

Abstract

Extended-release guanfacine (Intuniv) is a novel long-acting, once-daily formulation of guanfacine indicated for attention deficit hyperactivity disorder (ADHD) in 6 to 17 year old children and adolescents. In doses 1 to 4 mg/day, guanfacine extended release (GXR) significantly improves the symptoms of inattention and hyperactivity-impulsivity in ADHD youngsters compared with placebo. Because of different pharmacokinetics, GXR is not substitutable on a mg-for-mg basis with immediate release guanfacine. Although extended release guanfacine does not demonstrate clinically significant ECG changes, mild slowing of the heart rate and some lowering of SBP and DBP does occur and requires vital sign monitoring during treatment. Children with a clinically significant cardiovascular history are not eligible for GXR therapy. Future research is exploring GXR effectiveness in ADHD complicated by oppositional defiant symptoms, ADHD complicated by tic disorders, posttraumatic stress disorders, and impulsive aggression in ADHD youngsters.

Practitioner Review: Emotional dysregulation in attention‐deficit/hyperactivity disorder – implications for clinical recognition and intervention

“…Connor et al. reviewed the literature on guanfacine extended‐release effects in children and adolescents (Connor, Arnsten, Pearson, & Greco, ), concluding that this medication was promising for problems of emotional dysregulation associated with ADHD. To date, double‐blind, placebo‐controlled trials of short‐ and long‐acting formulations of α‐2 adrenergic agonists for treating ADHD in children and adults have not specifically examined effects on emotional dysregulation.…”

The utility of rat models of impulsivity in developing pharmacotherapies for impulse control disorders

“…Despite the fact that much of the ADHD literature is still dominated by research into the DA system, there has been a growing resurgence of interest in the hypothesis that NA plays a key role in both the aetiology and treatment of this disorder (Biederman and Spencer, 1999; Biederman et al ., 2006; Arnsten et al ., 2007; Arnsten, 2009). The selective NA reuptake inhibitor atomoxetine (Strattera™) is currently one of the few non‐stimulant medications found to be effective in treating ADHD (Spencer et al ., 2002b; Simpson and Perry, 2003), and the α 2A receptor agonist guanfacine has recently also been approved for treatment of this disorder (Connor and Rubin, 2010; Muir and Perry, 2010). Although bupropion, a DA‐NA reuptake inhibitor, has also been suggested as a treatment for ADHD in subjects with co‐morbid substance abuse (Conners et al ., 1996; Riggs et al ., 1998; Levin et al ., 2002), its efficacy at reducing ADHD symptoms appears lower than for other prescription drugs (Spencer et al ., 2002b).…”

A Phase II Double-Blind, Placebo-Controlled, Efficacy and Safety Study of SPN-812 (Extended-Release Viloxazine) in Children With ADHD

“…However, they are generally considered to be less effective than stimulants based on their lower effect size, and they have a more gradual onset of action. In addition, nonstimulants may be associated with problematic side effects, such as rebound hypertension (α 2 agonists), decreased appetite (atomoxetine), and sedation/somnolence (all) (Briars & Todd, 2016;Childress & Tran, 2016;Clemow & Bushe, 2015;Connor, Arnsten, Pearson, & Greco, 2014;Huss, Chen, & Ludolph, 2016;Shire US Inc., 2017). In short, although currently approved medications for ADHD are generally associated with moderate to robust symptom improvement, they may not be optimal for some patients (Briars & Todd, 2016).…”