Guanfacine extended release for the treatment of attention-deficit/hyperactivity disorder in children and adolescents

Introduction: Guanfacine extended release (GXR) is a selective alpha(2A)-adrenoreceptor agonist originally developed as an antihypertensive agent and now FDA approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) as monotherapy and as adjunctive to psychostimulants in children and adolescents 6 - 17 years old. Areas covered: Search of the PubMed and Psyclnfo databases from 1990 to 2014 using the search term 'guanfacine'. Studies selected for review were either controlled or open trials of guanfacine or GXR. Shire Pharmaceuticals, Inc. was contacted and supplied a synopsis of all available ADHD studies on GXR for review. Expert opinion: GXR is an evidence-based treatment for ADHD in children and adolescents. Because this compound has a smaller effect size than psychostinnulants for the symptoms of ADHD, it is generally considered a second-line treatment after the psychostimulants or in combination with psychostimulants. Evidence for efficacy is more robust in children than for adolescents. Because of its pharmacodynamic actions in prefrontal cortex, GXR shows considerable promise for other behavioral conditions frequently comorbid with ADHD and potential promise for emotional and behavioral dysregulation secondary to traumatic stress.