Which medications in the drug class Alpha2-adrenergic Agonists are used in the treatment of Pediatric Attention Deficit Hyperactivity Disorder (ADHD)?

Updated: Nov 20, 2018
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
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Answer

Alpha2-adrenergic Agonists

Alpha2-adrenergic agonists can be helpful in treating hyperactivity, tics, or delayed sleep onset. They have a long history of pediatric use for this indication. Rare cases of sudden death had been reported several years ago in a few children who were given clonidine with concurrent methylphenidate. Reports also described fatal ventricular fibrillation in patients in whom treatment with clonidine was abruptly stopped rather than slowly tapered, as is appropriate. Details of these cases do not substantiate a cause-and-effect association, only concurrence.

The FDA has not stated that these drugs should not be simultaneously used. Nevertheless, a prudent approach is to avoid using these drugs together in any patient with a first-degree relative who died from a sudden cardiac cause without first getting an ECG. Obtaining an ECG in any patient who may benefit from this combination but who has a history of arrhythmia is also prudent. Most experts continue to use clonidine with any of the stimulants when clinically indicated.

The data from one study suggest that morning or evening guanfacine extended release (GXR; ≤4 mg/d) adjunctive to a long-acting psychostimulant resulted in improvement in ADHD symptoms over psychostimulants used alone. [20]

An extended-release clonidine (Kapvay) was approved by the FDA in September 2010 as adjunctive therapy to stimulants for ADHD or as monotherapy.

Guanfacine (Intuniv)

Selectively stimulates alpha2a-adrenoreceptors in brainstem, activating an inhibitory neuron, which reduces sympathetic outflow. This action results in decreased vasomotor tone and HR. The mechanism of action of guanfacine in ADHD is not known. Indicated for ADHD. Effectiveness for long-term use (ie, >9 wk) has not been studied in controlled trials

Clonidine (Kapvay)

Stimulates alpha2-adrenoreceptors in brainstem, activating an inhibitory neuron, which reduces sympathetic outflow. Result is decreased vasomotor tone and HR. Mechanism for ADHD unknown. Extended-release form indicated for ADHD as adjunctive therapy to stimulants or as monotherapy.


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