Can Arian stop taking Intuniv (guanfacine) after switching from Risperidone (Risperdal) and undergoing stem cell therapy?

Discontinuing Guanfacine (Intuniv) After Stem Cell Therapy

Based on the available evidence, there is insufficient support to discontinue guanfacine (Intuniv) after stem cell therapy, and medication should be continued unless significant side effects are present or complete symptom resolution has been maintained for at least 6 months.

Assessment of Current Medication Status

Guanfacine (Intuniv) is an alpha-2 adrenergic receptor agonist that is FDA-approved for treating attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. The patient has been switched from risperidone 0.5ml to guanfacine 2mg after undergoing stem cell therapy.

Considerations for Discontinuation

When evaluating whether to discontinue guanfacine, several factors must be considered:

1. Current symptom control:

   • Is the patient currently experiencing good symptom control on guanfacine?
   • Has there been a sustained period of symptom stability?

2. Risks of discontinuation:

   • Guanfacine should not be stopped abruptly due to risk of rebound hypertension
   • The FDA drug label states: "Rebound hypertension after abrupt guanfacine discontinuation has been observed, these medications should be tapered off rather than suddenly discontinued" 1

3. Duration of treatment:

   • For neurodevelopmental disorders, medication management is typically long-term
   • No evidence suggests that stem cell therapy eliminates the need for medication

Evidence-Based Recommendation

There is no clinical evidence supporting that stem cell therapy can replace the need for guanfacine or other medications for neurodevelopmental or behavioral disorders. The Practice Parameter for the Assessment and Treatment of Children and Adolescents with Autism Spectrum Disorder 2 indicates that medications like guanfacine are used for specific target symptoms and should be continued as long as those symptoms require management.

Monitoring and Tapering Approach

If discontinuation is being considered:

1. Gradual tapering is mandatory:

   • Reduce dose by no more than 25% every 3-7 days
   • Monitor for rebound symptoms including increased blood pressure, agitation, and return of original symptoms

2. Monitoring parameters during tapering:

   • Blood pressure and heart rate (guanfacine can cause hypotension and bradycardia)
   • Return of target symptoms
   • Emergence of withdrawal symptoms

Common Side Effects to Consider

Guanfacine has several common side effects that might influence the decision to continue or discontinue:

• Somnolence (14-39% of patients)
• Dry mouth (up to 28%)
• Dizziness (4-15%)
• Constipation (1-15%)
• Fatigue (4-10%)
• Hypotension and bradycardia 1

Follow-up Recommendations

If continuing guanfacine:

• Regular monitoring of blood pressure, heart rate, and weight
• Assessment of symptom control every 3-6 months
• Evaluation for side effects at each visit

If considering discontinuation:

• Only attempt after at least 6 months of stable symptom control
• Implement a slow taper over 2-4 weeks
• Schedule more frequent follow-ups during the tapering process
• Be prepared to restart medication if symptoms return

Conclusion

Without specific information about the patient's current symptom control, duration of treatment, or the specific condition being treated, the safest recommendation is to continue guanfacine unless there are significant adverse effects or complete symptom resolution has been maintained for at least 6 months. There is no evidence that stem cell therapy eliminates the need for medications like guanfacine, and abrupt discontinuation poses significant risks.