View Full Version : Guanfacine Dosing Schedule?


KDLMaj
06-20-09, 02:46 AM
Hey folks-

Doc started me on guanfacine today in addition to my dex/vyvanse. The trick is, doc is two weeks away from retiring and doesn't care, so I basically wrote my own prescription (1mg/day for the first month and 2 mg/day the second month- probably should have gone for 2mg/day for both months just to be safe). Having said that, I haven't found a ton of info on proper dosing- though enough to get me started at least. I have heard several folks discuss it, and the answers have ranged.

Does anyone have any info on the clinical duration of action for a single dose of guanfacine? The half life is long, but as with most meds (particularly ADD meds unfortunately) there seems to be a divergence between blood plasma levels and therapeutic efficacy.

Alternately, I'd love to hear what people are specifically taking (and what they started on). My plan for now is .5mg in the AM and .5mg in the PM for the first month, then I'll move on to .5mg 3x/day. But I want some more data to back up that plan.

Sine
06-21-09, 09:00 PM
This will take some time to work out. I just started with guanfacine recently; prescribed 2 mg per day. I think this was a little too much for me, and I think it lasts about 2 days in the body - but I had to find this out the hard way. I took my first dose of 2 mg before bed, and the next day, I could feel my blood pressure was lower. I was a little dizzy when coming up from tying my shoes, but other than that, no issues. That night, I took my second dose (24 hours after the first), and the morning after, I was in bad shape. Just after waking up and turning on the shower, I blacked out for a minute and woke up on the floor of the tub! Not good. :D

I took a double dose of dexedrine just to be able to stand up that day, and I've learned my lesson to take it every other day. For now, I cut my dose in half as well, just because. I think I'll go back to 2 mg - but every other day - because I haven't really seen any effects from it so far.

Captain Obvious
06-21-09, 09:54 PM
I think I'll go back to 2 mg - but every other day - because I haven't really seen any effects from it so far.


"Effects"? What effects are you looking for, exactly. It's a blood pressure medication, not a psychostim. You're not gonna see much in the area of cognitive effects from it... at least none that are profound.

That being said, there is an unusually large concentration of Alpha-2 receptors in the prefrontal cortex of the brain (compared to the rest of the brain). The prefrontal cortex is one of the key areas of the brain dealing with ADD, because it controls conscious decision making and partially attention. Since guanfacine is an alpha-2 agonist, it DOES stimulate the prefrontal cortex. However, this stimulation is quite subtle, and you'll only notice it after the first few days of "initiation" to the drug.

This "initiation" or "get to know you" stage is the first week or so, which is what you both are dealing with. I've been there. The best way to describe it is that feeling you get after you've done a hard workout. Total muscle exhaustion. Maybe a little mental slowness, too, but it's mostly physical. But this passes quickly. Pretty soon you'll feel right back to normal. Your alpha-2 receptors will de-sensitize a little bit so you won't feel so exhausted, but not enough so that it doesn't help lower your blood pressure.

And that's the main point of the medicine... to combat the nasty blood pressure side-effects of ADD stims like adderall and ritalin and reduce the risk of heart problems.

KDLMaj
06-21-09, 10:56 PM
I'm going to have to disagree with some of what you've said captain. Yes it's a blood pressure medicine (not really honestly- these days guanfacine and clonidine aren't commonly prescribed- they're not effective monotherapies), but the reduction in ADHD symptoms for ADHD-C folks is equivalent to dexedrine (though that's on global scales- hyperactivity/impulsivity seems to have a greater decrease than inattention symptoms for most).

So it's not 'just' a blood pressure medication. And if it weren't clinically useful, Shire wouldn't be blowing a lot of money on Intuniv (and Addrendex on Clonicel- clonidine's upcoming 24 hour formulation) when the competition is already tight among drugs (there are roughly 19 formulations of methylphenidate and amphetamine on the US market already- not counting Strattera, Wellbutrin, Provigil, etc).

Having been on it for a few days now, I can definitely say it works. I'm REALLY hoping the dazed out feeling will go away-I think this is mostly mild sedation and blood pressure dropping. I haven't felt this calm in a long time- so I'm optimistic.

To the original responder- I had the same problem you had! The first day I took my normal dose (I started REALLY low- I basically wrote my own prescription, just told the doc what I wanted, so I started off with .5mg), but the next day I took 1mg and woke up totally blasted the morning after that day. So I'll stick with .5mg for now and take it from there.

KDLMaj
06-21-09, 10:59 PM
I'm going to have to disagree with some of what you've said captain. Yes it's a blood pressure medicine (not really honestly- these days guanfacine and clonidine aren't commonly prescribed- they're not effective monotherapies), but the reduction in ADHD symptoms for ADHD-C folks is equivalent to dexedrine (though that's on global scales- hyperactivity/impulsivity seems to have a greater decrease than inattention symptoms for most).

So it's not 'just' a blood pressure medication. And if it weren't clinically useful, Shire wouldn't be blowing a lot of money on Intuniv (and Addrendex on Clonicel- clonidine's upcoming 24 hour formulation) when the competition is already tight among drugs (there are roughly 19 formulations of methylphenidate and amphetamine on the US market already- not counting Strattera, Wellbutrin, Provigil, etc).

Having been on it for a few days now, I can definitely say it works. I'm REALLY hoping the dazed out feeling will go away-I think this is mostly mild sedation and blood pressure dropping. I haven't felt this calm in a long time- so I'm optimistic.

To the original responder- I had the same problem you had! The first day I took my normal dose (I started REALLY low- I basically wrote my own prescription, just told the doc what I wanted, so I started off with .5mg), but the next day I took 1mg and woke up totally blasted the morning after that day. So I'll stick with .5mg for now and take it from there.

lk44
06-24-09, 05:59 PM
About 60% of patients on guanfacine (http://medicalissuesnew.blogspot.com/2009/06/adhd-or-attention-deficit-hyperactive.html) are much or very much improved. I'm glad to hear that you're among them, KDLMaj!

KDLMaj
06-25-09, 03:48 AM
Thanks, I'll go ahead and give an update now:

Side effects finally faded a bit, and so naturally I threw myself up to .5mg 2x/day yesterday, and boy did I get my butt kicked again today. I'm utterly exhausted, but the good news is that I'll be on this 1mg a day for the next month before I titrate back up again. So that'll be time to settle in. I'm shooting for 2mg/day. The exhaustion is rough given I work 6 days a week and easily 55 hours. But I remain calmer and less impulsive, and given that we're all going to spend rest of our lives on medication- what's a month or two of side effects?

bobC
06-25-09, 04:14 AM
alpha2 receptors are actually very slow to change like dopamine receptors. It takes on the order of months for down/up regulation to occur.

Alpha2 receptors are inhibatory and increase the rate of ne reuptake. So you will not see any cognitive improvement from an agonist. The main problem I had on clonidine was a reduction in temporal stimulation to the point I began missing non-verbal cue's.

I think that upregulation of alpha2 receptors is quite common for adhd and add people due to long term deficiencies in NE. I also speculate that to some degree alpha2 receptor regulation is a factor seperating the subtypes of adhd.

BobC

KDLMaj
06-25-09, 01:37 PM
Yup, sadly much slower than say stimulants. I figure I'll be spending the next 2 months dealing with side effects and dosage titration. Having said that, it doesn't take months for the medication to begin working (clinical trials show some improvement within a week), though it takes a few weeks to reach max effect.

The notion that guanfacine and clonidine aren't cognitive enhancing is actually untrue. There are several human studies demonstrating mild to moderate enhancement in various measures of memory, and the recent Intuniv clinical trials have shown improvements on measures of attention- though not as much as we see with stimulant medication.

lforman
08-24-09, 03:55 AM
I've been on guanfacine for about a month at 1mg 2x a day. I'm also on Sevilla which is for fibromyiagia. Its targets NE 8x more than Cymbalta. Studies show that NE reuptake ? is related to chronic pain.

Also I may have the inattentive side and organization problems, the lesson that the universe always throws at me is to Slow Down!. Still working on it. Even when I am not working and have free time, my brain is like a porche and will never be a family sedan. Sounds fun, but now after so many years I have chronic fatigue.

Hope this drug works as an addition to all my relation tapes, mediation etc

Lisa

Captain Obvious
08-24-09, 10:37 AM
I'm going to have to disagree with some of what you've said captain. Yes it's a blood pressure medicine (not really honestly- these days guanfacine and clonidine aren't commonly prescribed- they're not effective monotherapies), but the reduction in ADHD symptoms for ADHD-C folks is equivalent to dexedrine (though that's on global scales- hyperactivity/impulsivity seems to have a greater decrease than inattention symptoms for most).

So it's not 'just' a blood pressure medication. And if it weren't clinically useful, Shire wouldn't be blowing a lot of money on Intuniv (and Addrendex on Clonicel- clonidine's upcoming 24 hour formulation) when the competition is already tight among drugs (there are roughly 19 formulations of methylphenidate and amphetamine on the US market already- not counting Strattera, Wellbutrin, Provigil, etc).

Having been on it for a few days now, I can definitely say it works. I'm REALLY hoping the dazed out feeling will go away-I think this is mostly mild sedation and blood pressure dropping. I haven't felt this calm in a long time- so I'm optimistic.

To the original responder- I had the same problem you had! The first day I took my normal dose (I started REALLY low- I basically wrote my own prescription, just told the doc what I wanted, so I started off with .5mg), but the next day I took 1mg and woke up totally blasted the morning after that day. So I'll stick with .5mg for now and take it from there.

"Aren't commonly prescribed"? "Aren't effective monotherapies"? O rly?

I'm no cardiologist, so feel free to prove me wrong, but I'm pretty sure this stuff is quite fantastic for blood pressure. My blood pressure before starting guanfacine was around 148/100. NOT normal for an otherwise healthy 22 year old. My stims were the sole reason for those numbers.

Once I got started on 1.5mg/d guanfacine, my blood pressure went back to normal healthy levels.

My grandfather is on clonidine currently for his age-related blood pressure (i.e. he doesn't have ADD), and it works quite well for him. However he has told me the same sides as you guys have had. He takes it at night. Admittedly, though, it's not a monotherapy, as he's on quite a few BP meds, including Warfarin.

My original point, though, was not to say that is was solely a blood pressure medicine. I believe you may have misinterpreted my post.

It DOES have quite a few good cognitive benefits, especially pertaining to organisation and executive function. It makes one feel more "together" and "with it."

I was merely pointing out to the OP that they shouldn't expect drastic cognitive change like they would experience with amphetamines. Yes, I have seen the study that shows its treatment efficacy being equal to dexedrine. But those were hyperactive 12 year olds. It helped them mostly cause it calmed them down. A shot or two of Jack would've yielded comparable results. =P

Okay... maybe not so much the whiskey... (although I DO believe that any sedation-inducing drug would have an effect in low doses, cause it keeps your mind from bouncing around the walls. Too much, of course, would be counter-productive... cause now you're DRUNK and ADHD... yay!!)

But the point is that alpha-2 receptors are negative feedback systems. They are the ones that say "too much norepinephrine!" Causing you to produce less. For that very same reason, it's also a stress reliever.... Keeps thoughts from bouncing around everywhere. My doctor (who was actually one of the first to research the benefits of clonidine for ADHD) puts it best: It reduces your mind's "intensity." For this reason you must watch your dose carefully, because too little intensity is just as bad as too much.

In all honesty, I experienced side effects for three days. that's it. It was really only two, because during the third day it was barely perceptable, but it was totally gone by the fourth.

If you're experiencing sides for WEEKS at a time (let alone months) for God's sake, lower your dose! Blood pressure shouldn't be a problem at this point (in fact, you may be HYPOtensive) and DEsensitizing alpha-2 receptors too much is a bad idea. For many reasons.... for one, it could lead to irritable bowels (angry poo!!) if you ever miss a dose... or, on the flip-side, stimulating the receptor too much would require Drain-O to loosen.:eek:

lforman
09-09-09, 09:18 PM
As I mentioned before I was on 1mg 2x a day of G. I've been exhausted and now gong down to .5 2x

Lisa