Centrally acting α2A agonist
Guanfacine
Brand names: Intuniv
Adult dose
Dose: Specialist — usually start 1mg OD, titrate by 1mg/week (weight-based) to max 4–7mg/day
Route: PO
Frequency: OD
Clinical pearls
- ADHD in children/adolescents (6–17) where stimulants ineffective/inappropriate
- Taper to discontinue — abrupt withdrawal can cause rebound hypertension
Contraindications
- Concurrent moderate/strong CYP3A4 modulators without adjustment
- 2nd/3rd-degree heart block
Side effects
- Somnolence
- Bradycardia
- Hypotension
- Headache
- Abdominal pain
- Rebound hypertension on abrupt withdrawal
Interactions
- CNS depressants (additive sedation)
- Antihypertensives
- CYP3A4 inhibitors/inducers
Monitoring
- BP
- HR
- Weight
Reference: BNF; NICE NG87; SmPC; https://bnf.nice.org.uk/drugs/guanfacine/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185 / BNF