What is the appropriate dosing of Melo Finity (guanfacine) extended release for a 6-year-old child with Attention Deficit Hyperactivity Disorder (ADHD)?

Dosing of Guanfacine Extended Release (Melo Finity) for a 6-Year-Old with ADHD

For a 6-year-old child with ADHD, start guanfacine extended release (Melo Finity) at 1 mg once daily, with gradual weekly increases of 1 mg based on response and tolerability, up to a maximum of 4 mg daily.

Initial Approach and Considerations

• For preschool and young school-aged children (ages 4-6), behavior therapy should be considered as first-line treatment before initiating medication therapy 1, 2
• When medication is necessary for a 6-year-old with moderate-to-severe ADHD symptoms that have not responded adequately to behavioral interventions, pharmacological treatment should be initiated 1, 2
• Guanfacine extended release (GXR) is FDA-approved for children 6 years and older with ADHD, making it an appropriate option for this patient 2, 3

Dosing Protocol

• Starting dose: Begin with 1 mg once daily 2
• Titration: Increase dose by 1 mg increments weekly based on clinical response and tolerability 1, 2
• Target dose range: 0.05 to 0.12 mg/kg/day or 1 to 4 mg/day for a 6-year-old 1, 2
• Maximum dose: Generally 4 mg daily for a child this age, though some guidelines allow up to 6 mg daily in older children 1, 2

Monitoring Requirements

• Assess blood pressure and heart rate at baseline and regularly during treatment, as guanfacine can cause reductions in these parameters 2, 3
• Monitor for common side effects including:
  • Somnolence/sedation (most common adverse effect) 1, 3
  • Fatigue and drowsiness 1
  • Dry mouth 1
  • Decreased appetite 2

Clinical Pearls and Considerations

• Guanfacine extended release has a different mechanism of action than stimulants, working as an alpha-2A adrenergic receptor agonist 3
• Unlike stimulants that work primarily on dopamine and norepinephrine reuptake, guanfacine modulates noradrenergic activity in the prefrontal cortex 3
• The extended-release formulation allows for once-daily dosing, which can improve medication adherence compared to multiple daily dosing 3
• Guanfacine should not be discontinued abruptly; gradual dose reduction is recommended to avoid rebound hypertension 2

Special Considerations for Young Children

• Young children may be more sensitive to side effects, particularly sedation, so careful monitoring is essential 2
• The efficacy of guanfacine in young children has been established, with significant improvements in ADHD symptoms compared to placebo 3
• Consider timing the dose to manage the sedative effects - evening dosing may be beneficial if daytime sedation is problematic 2

Alternative Options

• If guanfacine extended release is not effective or poorly tolerated, consider:
  • Stimulant medications (methylphenidate or amphetamine formulations) which are considered first-line pharmacological treatment for ADHD 1, 2
  • Atomoxetine as an alternative non-stimulant option 1, 2

Remember that medication management should be combined with behavioral interventions for optimal outcomes in managing ADHD symptoms in young children 1, 2.