Adult dose and durationA paediatric drug, not an adult one. SmPC verbatim: "The safety and efficacy of guanfacine in adult and the elderly with ADHD has not been established. Therefore, guanfacine should not be used in this group." The child and adolescent regimen is on the paediatric line below. - Not applicable - the licence stops at 17 years.
Paediatric dose0.05-0.12 mg/kg/day [child max 7 mg]
(1 mg once daily to start, raised by no more than 1 mg a week, weight-banded. SmPC verbatim: "For all patients, the recommended starting dose is 1 mg of guanfacine, taken orally once a day." and "The dose may be adjusted in increments of not more than 1 mg per week." Target band verbatim: "the recommended maintenance dose range is 0.05-0.12 mg/kg/day." Ceilings by weight, from the SmPC's own tables - children 6 to 12 years, 25 kg and up: maximum 4 mg. Adolescents 13 to 17 years: 34-41.4 kg maximum 4 mg; 41.5-49.4 kg maximum 5 mg; 49.5-58.4 kg maximum 6 mg; 58.5 kg and above maximum 7 mg, and that top step only "after the subject has completed a minimum of 1 week of therapy on a 6 mg/day dose". "Adolescent subjects must weigh at least 34 kg.")
Age restriction: 72-215 months
Not for children under 25 kg
Dose by age| 6 to 12 years: | 1 mg once daily to start, raised by no more than 1 mg a week, to a maintenance range of 0.05 to 0.12 mg/kg/day. Maximum 4 mg daily, at 25 kg and above. |
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| 13 to 17 years: | 1 mg once daily to start, raised by no more than 1 mg a week, to 0.05 to 0.12 mg/kg/day. Maximum by weight: 34 to 41.4 kg, 4 mg; 41.5 to 49.4 kg, 5 mg; 49.5 to 58.4 kg, 6 mg; 58.5 kg and above, 7 mg - and only after a minimum of 1 week on 6 mg daily. Must weigh at least 34 kg. |
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Dose by weight| 25kg | 1.2-3 mg/day |
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| 26kg | 1.3-3.1 mg/day |
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| 27kg | 1.4-3.2 mg/day |
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| 28kg | 1.4-3.4 mg/day |
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| 29kg | 1.5-3.5 mg/day |
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| 30kg | 1.5-3.6 mg/day |
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| 31kg | 1.6-3.7 mg/day |
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| 32kg | 1.6-3.8 mg/day |
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| 33kg | 1.7-4 mg/day |
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| 34kg | 1.7-4.1 mg/day |
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| 35kg | 1.8-4.2 mg/day |
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| 36kg | 1.8-4.3 mg/day |
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| 37kg | 1.9-4.4 mg/day |
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| 38kg | 1.9-4.6 mg/day |
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| 39kg | 2-4.7 mg/day |
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| 40kg | 2-4.8 mg/day |
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| 41kg | 2.1-4.9 mg/day |
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| 42kg | 2.1-5 mg/day |
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| 43kg | 2.1-5.2 mg/day |
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| 44kg | 2.2-5.3 mg/day |
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| 45kg | 2.2-5.4 mg/day |
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| 46kg | 2.3-5.5 mg/day |
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| 47kg | 2.4-5.6 mg/day |
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| 48kg | 2.4-5.8 mg/day |
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| 49kg | 2.5-5.9 mg/day |
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| 50kg | 2.5-6 mg/day |
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Dose sourceIntuniv 4 mg prolonged-release tablets SmPC sections 4.1 and 4.2 (eMC product 7507)
WhyThe disease article names it, verbatim: "Lastly, alpha agonists such as clonidine and guanfacine can be used as an effective treatment for ADHD." and it says where it fits - "They are found to be more effective in younger children than adults." The SmPC's indication section names the disease and the patient, verbatim: "Intuniv is indicated for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents 6-17 years old for whom stimulants are not suitable, not tolerated or have been shown to be ineffective." It sits beside atomoxetine as the second non-stimulant option. Egypt registers no guanfacine product, so no brand and no price can be shown.
Cautions- Never stopped abruptly. SmPC verbatim: "When stopping treatment, the dose must be tapered with decrements of no more than 1 mg every 3 to 7 days, and blood pressure and pulse should be monitored in order to minimise potential withdrawal effects, in particular increases in blood pressure and heart rate".
- Blood pressure, pulse, height and weight before the first tablet. SmPC verbatim: the baseline evaluation "should address a patient's cardiovascular status including blood pressure and heart rate, documenting comprehensive history of concomitant medications, past and present co-morbid medical and psychiatric disorders or symptoms, family history of sudden cardiac/unexplained death and accurate recording of pre-treatment height and weight on a growth chart".
- Sedation and low blood pressure are dose-related and come early. SmPC verbatim: "Patients should be advised that somnolence and sedation can occur, particularly early in treatment or with dose increases. If somnolence and sedation are judged to be clinically concerning or persistent, a dose decrease or discontinuation should be considered." Weekly checks during titration - "During dose titration, weekly monitoring for signs and symptoms of somnolence and sedation, hypotension and bradycardia should be performed."
- Two missed doses means starting the titration again. SmPC verbatim: "If two or more consecutive doses are missed, re-titration is recommended based on the patient's tolerability to guanfacine."
- Prolonged-release and immediate-release are not the same milligram. SmPC verbatim: "Immediate-release guanfacine tablets should not be substituted on a mg/mg basis, because of differing pharmacokinetic profiles."
- The disease article's own warning about the class: it links these drugs to a range of cardiovascular effects, blood pressure falling among them, along with sedation - more with clonidine than with guanfacine - weight gain and dizziness.
Egyptian brandsNo Egyptian brand matched — prescribe by generic name.