UMEM Educational Pearls

Category: Toxicology

Title: pediatric guanfacine exposure

Keywords: guanfacine, ADHD, pediatric, toxicity (PubMed Search)

Posted: 5/3/2019 by Hong Kim, MD, MPH (Updated: 7/18/2019)
Click here to contact Hong Kim, MD, MPH

 

Guanfacine is a presynaptic alpha-2 adrenergic receptor agonist (similar to clonidine) that is FDA approved to treat ADHD in pediatric patients 6 years of age and older. A recently published study characterized the pediatric exposure to guanfacine between 2000 and 2016.   

  • 10927 single exposures to guanfacine were identified.
  • Guanfacine exposure increased in all age group starting 2009
  • Highest exposure rate was in 6-12 years old population

Most frequently reported clinical effect (n=10927)

  • Drowsiness (n=4262; 39.0%)
  • Bradycardia (n=1696; 15.5%)
  • Hypotension (n=1127; 10.3%)
  • Dizziness (n=279; 2.6%)
  • Hypertension (n=199; 1.8%)

Severe clinical effects (n=10927)

  • Respiratory depression (n=47; 0.43%)
  • Coma (n=24; 0.22%)
  • Respiratory arrest (n=5; 0.05%)
  • Cardiac arrest (n=1; 0.01%)

Duration of clinical effect

  • 8 to 24 hours: > 80%

Conclusion

  • Severe toxicity (respiratory depression/arrest and cardiac arrest) is rare with unintentional guanfacine exposure.
  • If symptomatic, majority of the patients were asymptomatic within 24 hours.