Krzysztof Krajewski, Katarzyna Dąbrowska, Anna Szoszkiewicz, Jakub Wesołowski, Kacper Grudniewski, Tymon Skrzywanek, Stanisław Lipiak, Agnieszka Bienert

Guanfacine in the treatment of attention-deficit/hyperactivity disorder in children and adolescents: A review of efficacy, tolerability, and clinical applications

 

2026-09-09

Research’s subject. Guanfacine is a selective alpha-2A adrenergic receptor agonist used in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. The introduction of the extended-release formulation has significantly expanded the pharmacological treatment options for this disorder, particularly in patients with an inadequate response to stimulant medications, intolerance to these agents, or a need for combination therapy. Owing to its distinct mechanism of action and favorable safety profile, guanfacine represents a valuable addition to currently available pharmacological treatment options.

Purpose. To present current evidence on the efficacy, safety, and clinical role of guanfacine in the management of ADHD in children and adolescents, with particular emphasis on practical considerations regarding patient selection, treatment monitoring, and comparison with other medications used in the treatment of this disorder.

Material and methods. A narrative literature review was conducted using the PubMed and Google Scholar databases. Randomized clinical trials, observational studies, systematic reviews, and meta-analyses evaluating the use of guanfacine in children and adolescents were included in the analysis. Data regarding therapeutic efficacy, safety, adverse effects, pharmacokinetic properties, drug interactions, and practical principles of treatment management and monitoring were evaluated.

Results. Available evidence indicates that extended-release guanfacine demonstrates moderate but clinically meaningful efficacy in reducing symptoms of ADHD. The efficacy of guanfacine is superior to placebo but is generally lower than that observed with stimulant medications. Guanfacine may be used both as monotherapy and in combination therapy, particularly in patients with pronounced impulsivity, hyperactivity, behavioral disturbances, or coexisting neurodevelopmental disorders. The safety profile of guanfacine is well established and generally predictable. The most commonly reported adverse effects include somnolence, sedation, fatigue, and dose-dependent reductions in blood pressure and heart rate. Regular monitoring of cardiovascular parameters, consideration of drug interactions involving medications affecting the activity of cytochrome P450 isoenzyme 3A4, and gradual discontinuation of treatment are of particular clinical importance to reduce the risk of rebound hypertension and tachycardia following abrupt treatment withdrawal.

Conclusions. Guanfacine represents a valuable therapeutic option for the treatment of attention-deficit/hyperactivity disorder in children and adolescents, particularly as an alternative to stimulant medications or as part of combination therapy. Appropriate patient selection, individualized dose titration, and regular monitoring of treatment efficacy and safety enable optimization of therapeutic outcomes and improvement of patient functioning.

Keywords: attention deficit disorder with hyperactivity, guanfacine, child, adolescent, drug therapy.

© Farm Pol, 2026, 82(3): 141–150