From the Guidelines
Stopping Intuniv (guanfacine extended-release) on weekends can cause rebound hypertension and is not recommended. Intuniv should be taken consistently every day without interruption. Abruptly stopping this medication can lead to significant increases in blood pressure, heart rate, nervousness, anxiety, and worsening of the original symptoms being treated. Rebound effects typically occur because Intuniv works by stimulating alpha-2 adrenergic receptors in the brain, which reduces sympathetic outflow and lowers blood pressure. When the medication is suddenly discontinued, there can be a surge in sympathetic activity.
Key Considerations
- The risk of rebound hypertension is a significant concern when discontinuing guanfacine, as noted in the clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents 1.
- If dose adjustment is needed, it should be done gradually under medical supervision, typically reducing by no more than 1mg every 3-7 days.
- If a dose is missed, resume the regular schedule without doubling up.
- For patients who need to discontinue Intuniv completely, a physician-supervised tapering schedule is essential to minimize withdrawal effects and prevent dangerous blood pressure elevations.
Management of Rebound Hypertension
To minimize the risk of rebound hypertension, it is crucial to taper off guanfacine gradually, rather than suddenly discontinuing it, as recommended in the guideline 1. This approach helps to prevent significant increases in blood pressure and other withdrawal symptoms. By prioritizing a gradual tapering schedule, healthcare providers can ensure a safer and more effective management of patients taking Intuniv.
From the FDA Drug Label
The frequency of rebound hypertension is low, but it can occur When rebound occurs, it does so after 2 - 4 days, which is delayed compared with clonidine hydrochloride. In most cases, after abrupt withdrawal of guanfacine, blood pressure returns to pretreatment levels slowly (within 2 - 4 days) without ill effects.
The risk of rebound hypertension when Intuniv (guanfacine) is discontinued on weekends is low. Rebound hypertension, if it occurs, typically happens after 2-4 days of abrupt withdrawal. However, the provided information does not specifically address the risk of rebound hypertension when guanfacine is discontinued on weekends. Therefore, a conservative clinical decision would be to exercise caution and consider the potential risk of rebound hypertension if guanfacine is discontinued, even if only for a short period like weekends 2.
From the Research
Risk of Rebound Hypertension
The risk of rebound hypertension when Intuniv (guanfacine) is discontinued on weekends is a concern for patients taking this medication.
- Studies have shown that guanfacine has a relatively long elimination half-life, which allows for once-daily dosing 3.
- A study comparing the effects of abrupt cessation versus taper-down of guanfacine extended-release tablets found no clinically significant elevation of systolic or diastolic blood pressure in the abrupt-cessation group compared to the taper-down group 4.
- Another study found that up to 40 hours after abrupt drug withdrawal, no rebound hypertension was noted in the guanfacine group 5.
- A study on the withdrawal of guanfacine after long-term treatment in essential hypertension found that blood pressure recovered gradually over 2-4 days after withdrawal, but no symptoms suggesting catecholamine excess were encountered within 48 hours of withdrawal 6.
- However, it is important to note that the study on rebound pulmonary hypertension, although not directly related to guanfacine, highlights the potential risks of interrupting therapy and rebound effects 7.
Discontinuation and Rebound Effects
- The available evidence suggests that guanfacine can be discontinued without significant increases in blood pressure or other tolerability parameters, including adverse events 4, 5, 6.
- However, it is crucial to consider the individual patient's response to discontinuation and monitor blood pressure and other parameters closely.
- The studies provide evidence that guanfacine has a slow offset of hypotensive effect over 2-3 days, which may reduce the risk of rebound hypertension 6.