Is Guanfacine a Controlled Substance?
No, guanfacine is not a controlled substance—it is a non-controlled medication with no DEA scheduling, which makes it particularly advantageous in patients with substance use disorders or when stimulant diversion is a concern. 1, 2
Regulatory Status
Guanfacine is FDA-approved for ADHD treatment in children and adolescents aged 6-17 years, and it carries no controlled substance classification, eliminating DEA prescribing requirements and concerns about abuse potential 3, 1
The non-controlled status is a key clinical advantage that simplifies prescribing logistics—no special prescription forms, no quantity limits, and no monitoring for diversion 2
Clinical Implications of Non-Controlled Status
In patients with comorbid substance use disorders (including cocaine, opioids, or stimulant abuse), guanfacine is specifically recommended as a first-line ADHD treatment precisely because of its non-controlled status and lack of abuse liability 1, 2
The medication works through alpha-2A adrenergic receptor agonism rather than dopaminergic pathways involved in addiction, making it mechanistically distinct from stimulants that carry abuse potential 3, 2
Guanfacine provides continuous symptom control without the peaks and troughs that could trigger craving behaviors in patients with substance use histories 2
Comparison to Controlled ADHD Medications
Unlike methylphenidate and amphetamine-based stimulants (Schedule II controlled substances), guanfacine carries no risk of diversion, misuse, or development of tolerance 1, 2
This non-controlled status makes guanfacine particularly appropriate when prescribing in environments with high diversion risk, such as college settings or in patients with personal or family histories of substance abuse 2
Important Safety Considerations Despite Non-Controlled Status
While guanfacine is not controlled, it cannot be stopped abruptly—it must be tapered by 1 mg every 3-7 days to avoid rebound hypertension, tachycardia, and withdrawal phenomena 1, 4
Monitor blood pressure and heart rate at baseline and during dose adjustments, as guanfacine causes modest decreases (1-4 mmHg BP, 1-2 bpm HR) that are generally clinically insignificant but require surveillance 1
Common adverse effects include somnolence (38.6%), headache (20.5%), and fatigue (15.2%), which are typically mild to moderate and dose-related 1, 5