Episode Details
Back to Episodes79. When stimulants don't work: Guanfacine and Clonidine explained
Description
While stimulant meds are first-line treatment for ADHD, they do NOT work for everyone... or sometimes they only PARTIALLY help. So, what can you do in these situations?
- When is the right time to try a non-stimulant medication like Guanfacine and Clonidine (a.k.a - alpha-agonists?)?
- In which clinical situations can these alpha-agonists be helpful?
- How do you know when to switch from one stimulant to another stimulant
- When should you try adding on or switching to an alpha-agonist?
In this episode, Dr. Elise Fallucco talks about guanfacine XR (Intuniv) and clonidine (Kapvay/Onyda XR)—and how to decide whether to switch stimulants or augment them. Using an 11-year-old with improved attention on a stimulant but persistent impulsivity/oppositionality and dose-limiting side effects, she explains that switching is best when there’s little benefit or unacceptable side effects, while augmentation makes sense with partial response. She reviews key scenarios for alpha agonists: residual impulsivity/hyperactivity/behavior dysregulation, ADHD with tics, possible adjunct use in ADHD with anxiety (not primary anxiety treatment), and late-day rebound near bedtime. She describes “peanut butter and jelly” synergy with stimulants, monitoring vitals, dosing/titration, sedation differences (more with clonidine), and the need to taper to avoid rebound hypertension.
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