Guanfaxin sustained-release tablets (Intuniv) are selective alpha 2A adrenergic receptor agonists, mainly used for the treatment of ADHD in children and adolescents. Special attention should be paid to cardiovascular monitoring, dosage adjustment, and withdrawal reactions when using them. Individualized dosing regimens are required for special populations.

1. Indications

(1) Childhood ADHD: Single drug treatment for attention deficit hyperactivity disorder (ADHD) in children aged 6-17, which can improve symptoms of inattention and hyperactivity.

(2) Adjuvant therapy: Can be used in combination with stimulant drugs for ADHD patients who have poor response to monotherapy, reducing the dosage of stimulants.

(3) Comorbidity management: Suitable for ADHD patients with comorbidities such as oppositional defiant disorder and tic disorders, with better tolerance than traditional medications.

2. Medication precautions

(1) Cardiovascular monitoring

Baseline blood pressure and heart rate checks are required before medication, and regular monitoring is necessary during treatment. Avoid use in patients with severe heart disease, and reduce dosage if symptomatic hypotension or bradycardia occurs.

(2) Medication for special populations

Patients with liver dysfunction should reduce their dosage by 50%, and severe renal dysfunction (GFR<15mL/min) should be avoided. Use during pregnancy only when necessary, and it is recommended to suspend feeding during lactation.

(3) Medication withdrawal management

Sudden discontinuation of medication can cause rebound hypertension, and the dosage should be gradually reduced (by 25% every 3-7 days). Do not double the dosage if missed, continue with the original dose the next day.

(4) Drug interactions

CYP3A4 strong inhibitors (such as ketoconazole) can double the blood drug concentration and require a 50% reduction. Avoid combining with antihypertensive drugs and sedatives as it may enhance central inhibition.

(5) Medication regimen

Children should start taking 1mg/day in the morning and gradually increase their dosage by 1mg per week to maintain a daily intake of 1-4mg. The maximum dose for adults is 7mg/day. The whole tablet should be swallowed without breaking or chewing.