Ltb3105 asked
My son has been in 3 mg of guanfacine for one month. It is extended release. He was taking clonidine before. Does he need to be weaned off the guanfacine first or can he safely switch back to clonidine. Doctor said we can go back to clonidine if guanfacine doesn’t work. My son is extremely irritable & instead of being drowsy he has insomnia & seems agitated.
Answer
For safety reasonsyour son may need to be weaned (i.e. tapered) off the guanfacine first before restarting clonidine.
For most individuals who need to discontinue or change from guanfacineslowly decreasing the dose is a good idea to avoid side effects. As everyone's situation is different howeverit is important to discuss with the doctor the best way to do this for your situation.
Guanfacine For ADHD
Guanfacine is a medication used to treat several conditions including high blood pressure in adults and ADHD in children. For ADHD in childrenguanfacine works in the brain to improve attentionmemoryimpulse controland distractibility. It is started at low doses (1 mg once daily) and slowly increased by about 1 mg per week based on how the child responds.
Clonidine works in the same way as guanfacinebut there may be subtle differences we don’t know about. This may be why your son is irritable rather than drowsy.
For both drugsthe side effect of drowsiness is more common than insomniabut insomnia and irritability do occur in about 5-10% of people and guanfacine causes slightly more insomnia than clonidine.
Tapering Guanfacine
The safety of switching directly from guanfacine to clonidine has not been studied. It is known howeverthat guanfacine (and clonidine) should not be abruptly discontinued due to the risk of side effects. Of particular concern is rebound hypertension.
Sothe safest way to switch your son to clonidine may be to wean him off the guanfacine first before restarting clonidine. Your doctor howevermay have experience switching from one drug to the other and can do so safely.
It is best to discuss the situation with your doctor. If they recommend tapering guanfacinebe sure to follow the regimen you discuss. The following tapering method has been used successfully as one example:
- Decrease the dose of guanfacine by 1 mg every 3 to 7 days.
- As your son was on 3mg of guanfacinethis means he will reduce the dose to 2 mg per day for about a week and then 1 mg per day for about a week and then you can stop.
- You should not cut or break the guanfacine tablets.
The side effects of reducing too fast include:
- Increases in heart rate
- Increases in blood pressure
- Anxiety
- Headaches
If any of the above side effects occurit would be prudent to reduce the dose more slowly.
Summary
- It is not known if switching directly from guanfacine to clonidine is safe.
- Even though these drugs work in a very similar wayweaning off the guanfacine first may be a safe way to switch to clonidine.
- One tapering method includes decreasing the dose of guanfacine by about 1 mg per week and if increases in heart rate or blood pressure occurdecrease the dose even more slowly.
- Be sure to discuss with the doctor the best way to stop or switch from guanfacine for specific advice in your specific situation.
