Can an 18-year-old male with Attention Deficit Hyperactivity Disorder (ADHD) and anxiety take Lexapro (escitalopram) and Intuniv (guanfacine) together?

Combining Lexapro and Intuniv for ADHD and Anxiety in an 18-Year-Old Male

Yes, an 18-year-old male with ADHD and anxiety can safely take Lexapro (escitalopram) and Intuniv (guanfacine) together, as this combination targets the distinct neurobiological mechanisms of both conditions with minimal risk of clinically significant drug interactions.

Rationale for Combination Therapy

The combination of Lexapro and Intuniv addresses two distinct conditions through different mechanisms:

• Lexapro (escitalopram): A selective serotonin reuptake inhibitor (SSRI) that is effective for anxiety disorders 1
• Intuniv (guanfacine): An α-2 adrenergic agonist that is effective for ADHD symptoms 2, 3

Evidence Supporting This Combination

• The American Academy of Child and Adolescent Psychiatry (AACAP) recognizes α-2 agonists such as guanfacine as effective for ADHD in children and adolescents 2
• SSRIs like escitalopram are considered first-line treatments for anxiety disorders 1
• A case study demonstrated successful treatment of comorbid conditions using a similar combination of sertraline (another SSRI) and guanfacine 4

Safety Considerations

1. Drug Interactions: No significant pharmacokinetic interactions have been reported between SSRIs and α-2 agonists like guanfacine

2. Side Effect Profile:

   • Lexapro: Common side effects include nausea, headache, insomnia, and sexual dysfunction 1
   • Intuniv: Most common side effect is sedation; cardiovascular effects like modest reductions in blood pressure and heart rate can occur but are generally not clinically significant 3

3. Monitoring Recommendations:

   • Blood pressure and heart rate should be monitored due to potential cardiovascular effects of guanfacine
   • Watch for excessive sedation, especially during initial titration period
   • Monitor for effectiveness in treating both ADHD and anxiety symptoms

Implementation Strategy

1. Starting Medications:

   • Begin with one medication at a time to better identify the source of any side effects
   • Typically start with the medication treating the more severe/disabling condition first
   • Allow 1-2 weeks between initiating medications

2. Dosing Guidelines:

   • Lexapro: Start with 10 mg daily, may increase to 20 mg if needed 1
   • Intuniv: Start with lower dose (1 mg) and titrate gradually based on response and tolerability

3. Follow-up Schedule:

   • Initial follow-up within 1-2 weeks of starting each medication
   • Regular monitoring during dose titration
   • Once stable, follow-up every 1-3 months

Clinical Pearls

• This combination addresses both conditions through complementary mechanisms without significant risk of adverse interactions
• Sedation may be more pronounced initially when both medications are used together
• The AACAP specifically mentions that α-2 agonists like guanfacine can be used for ADHD, while SSRIs are recommended for anxiety 2
• Avoid abrupt discontinuation of either medication; both should be tapered gradually if discontinuation is necessary

Conclusion

The combination of Lexapro and Intuniv represents a rational pharmacological approach for treating comorbid ADHD and anxiety in an 18-year-old male, targeting the distinct neurobiological mechanisms of each condition with minimal risk of adverse interactions.