From the FDA Drug Label
There have been spontaneous postmarketing reports of mania and aggressive behavioral changes in pediatric patients with attention-deficit hyperactivity disorder (ADHD) receiving guanfacine hydrochloride
- Mania has been reported as a potential adverse effect of Guanfacine, specifically in pediatric patients with attention-deficit hyperactivity disorder (ADHD) 1.
- The reported cases were from a single center and all patients had medical or family risk factors for bipolar disorder.
- All patients recovered upon discontinuation of Guanfacine HCl.
- It is essential to exercise caution when prescribing Guanfacine to patients with a history of bipolar disorder or those at risk of developing mania.
From the Research
Guanfacine can potentially trigger mania in some individuals, particularly those with bipolar disorder or a predisposition to mood disorders, as reported in a case study from 1999 2. This medication, commonly prescribed for ADHD, hypertension, and sometimes for anxiety or tics, works by affecting norepinephrine activity in the brain. While not as commonly associated with mania as stimulants, guanfacine has been reported to occasionally precipitate manic episodes, with a higher risk in patients with a personal or family history of bipolar disorder. Some key points to consider when prescribing guanfacine include:
- Screening for bipolar disorder before prescribing guanfacine
- Monitoring patients closely, especially during dose adjustments
- Being aware of the potential for guanfacine to precipitate manic episodes, particularly in vulnerable individuals
- Recognizing the symptoms of mania, such as unusual elevation in mood, decreased need for sleep, increased energy, racing thoughts, or impulsive behavior, and contacting a healthcare provider immediately if these symptoms occur. It's also important to note that the most recent and highest quality study on this topic is from 1999 2, which highlights the need for further research on the potential for guanfacine to trigger mania. However, based on the available evidence, healthcare providers should exercise caution when prescribing guanfacine to individuals with a history of mood disorders or those who are at risk of developing mania. In terms of specific dosing, guanfacine is typically dosed at 1-4 mg daily, and patients should be monitored closely for any changes in mood or behavior. Overall, while guanfacine can be an effective treatment for ADHD and other conditions, its potential to trigger mania in some individuals must be carefully considered and monitored.