Guanfacine use in children with attention deficit hyperactivity disorder

The role of guanfacine in ADHD remains unclear. It may be reasonable to initiate a trial of guanfacine in a patient who has not responded to or cannot tolerate other agents due to adverse effects or drug dependence, or in a patient who develops motor tics. However, large placebo-controlled, double-blind, comparative trials involving guanfacine, stimulants, and/or TCAs are necessary to fully determine the role of guanfacine in the treatment of ADHD. Presently, behavioral modification is considered a first-line therapy and may be sufficient in mild cases of ADHD. Pharmacologic intervention or a combination of pharmacotherapy and behavioral modification should be tried in patients who cannot be adequately controlled with nonpharmacologic treatment. The stimulants still are considered first-line pharmacotherapy; however, guanfacine may have a role as a second- or third-line agent in patients who do not respond to or cannot tolerate stimulants or TCAs.