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Guanfacine (brand name Estulic, Tenex and the extended release Intuniv) is a sympatholytic drug used in the treatment of attention deficit hyperactivity disorder (ADHD) and hypertension.^[5] It is a selective α_2A receptor agonist. These receptors are concentrated heavily in the prefrontal cortex and the locus coeruleus, with the potential to improve attention resulting from interaction with receptors in the former.^[6] Guanfacine lowers both systolic and diastolic blood pressure by activating the central nervous system α_2A norepinephrine autoreceptors, which results in reduced peripheral sympathetic outflow and thus a reduction in peripheral sympathetic tone.^[7]

Guanfacine is currently approved and marketed in the United States as Intuniv^[8] and has been filed and is under investigation by the European Medicines Agency^[9] for the treatment of ADHD in children and adolescents aged 6–18 years.

Medical uses

Hypertension

It has been shown to reduce hypertension not just in the short-term, but also in long-term studies to be able to achieve normalization in the of blood pressure of 54% of patients treated over a year and 66% over two years. The average reduction in mean arterial pressure of all patients was 16% at the end of the first year and 17% at the end of the second year. ^[10]

1 mg guanfacine tablets.

Attention deficit hyperactivity disorder

The US Food and Drug Administration (FDA) has approved guanfacine for the treatment of attention deficit hyperactivity disorder (ADHD), like clonidine, alone or with stimulants in 2010, for pediatric patients aged 6–17 years.^[11] Its beneficial actions are likely due to its ability to strengthen prefrontal cortical regulation of attention and behavior.^[12] Guanfacine is also used in conjunction with stimulants to augment therapeutic actions, reduce rebound, and when taken at evening, to induce sleep.^[13] Guanfacine is thought to improve regulation of behavior, attention, and emotion through actions at post-synaptic α_2A adrenergic receptors on prefrontal cortical neurons, which strengthen prefrontal cortical network connections.^[14] In animal models, guanfacine is seen to affect a number of cognitive factors, including working memory improvement, distractibility reduction, response inhibition improvement, and enhanced attention and impulse control. Improvement is most evident in subjects with cognitive deficits; more subtle effects are seen in healthy young animals.^[12] Performance increases in spatial working memory have also been observed in humans.^[15] Another study found no effect on healthy male adults' executive functions and working memory, and small decrements on 2 tasks relating to the sedative effect of guanfacine.^[16] Recent studies suggest that guanfacine may help patients with a variety of prefrontal cortical disorders, including traumatic brain injury to the frontal lobe,^[17] strokes affecting higher cognitive function,^[18] and dysregulated emotional behavior, e.g. in children who have been traumatized.^[19]

Side effects of guanfacine are dose-dependent.^[20]

Anxiety

Another psychiatric use of guanfacine is for treatment of anxiety, such as generalized anxiety disorder and post-traumatic stress disorder symptoms. Guanfacine and other α_2A agonists have anxiolytic-like action,^[21] reducing sympathetic arousal in the emotional responses of the amygdala, and strengthen prefrontal cortical regulation of emotion, action and thought. Due to its prolonged half-life, it also has been seen to improve sleep interrupted by nightmares in PTSD patients.^[22] All of these actions likely contribute to the relief of the hyperarousal, re-experiencing of memory, and impulsivity associated with PTSD.^[23] However, a recent study showed no benefit for patients suffering from PTSD.^[24]

Tics

According to recent studies (Srour et al., 2008)^{[full citation needed]} there is controversy as to guanfacine’s usefulness in treating tics. There has been success when tic symptoms are co-morbid with ADHD, and as such, guanfacine and other α_2A-adrenergic agonists (clonidine) are commonly the first choice for treatment.

Treatment of withdrawal syndrome

Guanfacine is also being investigated for treatment of withdrawal for opioids, ethanol, and nicotine.^[25]

Adverse effects

Adverse effects incidence:^[2]
Very common (>10% incidence) adverse effects include:

Xerostomia (dry mouth)
Somnolence (sleepiness)
Fatigue
Dizziness
Headache
Constipation
Abdominal pain

Common (1-10% incidence) adverse effects include:

Alopecia (hair loss)
Asthenia (weakness)
Bradycardia (low heart rate)
Confusion
Increased appetite
Depression
Dermatitis
Diaphoresis (sweating without a physiologic reason)
Dizziness
Dyspepsia (indigestion)
Dysphagia (being unable to swallow)
Dyspnoea (air hunger)
Hypokinesia
Hypotension (low blood pressure)
Impotence
Insomnia
Irritability
Leg cramps
Lethargy
Nausea
Palpitations
Pruritus (itching)
Tachycardia (high heart rate)
Weakness

Unknown frequency adverse effects include:

Abnormal liver function tests
Agitation
Alterations in taste
Anxiety
Arthralgia (joint pain)
Blurred vision
Chest pain
Confusion
Diarrhoea
Exfoliation
Exfoliative dermatitis
Hallucinations
Impotence
Leg pains
Malaise
Myalgia (muscle pain)
Nervousness
Nocturia (waking to urinate)
Oedema (swelling)
Orthostatic hypotension
Paresthesia (pins and needles)
Rash
Tremor
Urinary frequency
Vertigo (dizziness)

Interactions

CYP3A4/5 inhibitors — Use caution. Elevates plasma concentration of guanfacine.
CYP3A4 inducers — Recommended increase in guanfacine dose.
Valproic acid — Use caution. Elevates plasma concentration of valproic acid.
Antihypertensive drugs — Use caution. Potential for additive pharmacodynamic effects (hypotension, syncope, etc.)
CNS depressant drugs — Use caution. Potential for additive pharmacodynamic effects (sedation, somnolence, etc.)

Pharmacokinetics and metabolism

Guanfacine has an oral bioavailability of 80%. There is no clear evidence of any first-pass metabolism. Elimination half-life is 17 hours with the major elimination route being renal. The principal metabolite is the 3-hydroxy-derivative, with evidence of moderate biotransformation, and the key intermediate being an epoxide.^[26] It is also shown that elimination in patients with impaired renal function does not differ significantly from those with normal renal function. As such, metabolism by liver is the assumption for those with impaired renal function, as supported by increased frequency of known side effects of orthostatic hypotension and sedation.^[27] In animal models, guanfacine’s enhancing effects on the working-memory functions of the pre-frontal cortex are thought to be due to inhibition of cAMP-mediated signaling, which is effected by the Gi proteins that are generally coupled to the post-synaptic alpha-2a-adrenoceptors that guanfacine stimulates through binding.^[28]

Pharmacology

Guanfacine is a highly selective agonist of the α_2A adrenergic receptor, with negligible affinity for any other receptor.^[29] However, may also be a potent 5-HT_2B receptor agonist, potentially contributing to valvulopathy.^[30]

Receptor	K_i (nM)
α_2A	71.8
α_2B	1200.2
α_2C	2505.2

Notes and references

^ ^a ^b ^c ^d ^e "Guanfacine (guanfacine) Tablet [Genpharm Inc.]". DailyMed. Genpharm Inc. March 2007. Retrieved 9 November 2013.
^ ^a ^b ^c ^d ^e ^f "guanfacine (Rx) - Intuniv, Tenex". Medscape Reference. WebMD. Retrieved 9 November 2013.
^ Hofer, Kristi N.; Buck, Marcia L. (2008). "New Treatment Options for Attention-Deficit/Hyperactivity Disorder (ADHD): Part II. Guanfacine". Pediatric Pharmacotherapy (Medscape) (14): 4.
^ Cruz, MP (Aug 2010). "Guanfacine Extended-Release Tablets (Intuniv), a Nonstimulant Selective Alpha(2A)-Adrenergic Receptor Agonist For Attention-Deficit/Hyperactivity Disorder.". P & T : a peer-reviewed journal for formulary management 35 (8): 448–51. PMC 2935643. PMID 20844694.
^ monograph
^ Kolar, Dusan; Keller, Amanda; Golfinopoulos, Maria; Cumyn, Lucy; Syer, Cassidy & Hechtman, Lily (2008), "Treatment of adults with attention-deficit/hyperactivity disorder", Neuropsychiatric Disease and Treatment 4 (2): 389–403, PMC 2518387, PMID 18728745 .
^ Van Zwieten, P.; Thoolen, M. & Timmermans, P. (1983), "The pharmacology of centrally acting antihypertensive drugs", British Journal of Clinical Pharmacology 15 (Suppl 4): 455S–462S, doi:10.1111/j.1365-2125.1983.tb00311.x, PMC 1427667 .
^ "FDA Approves Intuniv". Drugs.com. September 2009.
^ "Shire submits INTUNIV® (guanfacine extended release) Marketing Authorisation Application to EMA". PharmiWeb.com. 3 April 2014.
^ Jerie, P. (1980). "Clinical experience with guanfacine in long-term treatment of hypertension: Part I: efficacy and dosage". British Journal of Clinical Pharmacology 10 (Suppl 1): 37S–47S. doi:10.1111/j.1365-2125.1980.tb04903.x. PMC 1430120. PMID 6994777. .
^ Kornfield R, Watson S, Higashi A, Dusetzina S, Conti R, Garfield R, Dorsey ER, Huskamp HA, Alexander GC; Watson; Higashi; Conti; Dusetzina; Garfield; Dorsey; Huskamp; Alexander (April 2013). "Impact of FDA Advisories on Pharmacologic Treatment of Attention Deficit Hyperactivity Disorder". Psychiatric Services 64 (4): 339–46. doi:10.1176/appi.ps.201200147. PMC 4023684. PMID 23318985.
^ ^a ^b Arnsten AF (October 2010), "The use of α_2A adrenergic agonists for the treatment of attention-deficit/hyperactivity disorder", Expert Rev Neurother 10 (10): 1595–605, doi:10.1586/ern.10.133, PMC 3143019, PMID 20925474
^ Zito, Julie M.; Derivan, Albert T.; Kratochvil, Christopher J.; Safer, DJ; et al. (2008), "Off-label psychopharmacologic prescribing for children: History supports close clinical monitoring", Child and Adolescent Psychiatry and Mental Health 2 (1): 24, doi:10.1186/1753-2000-2-24, PMC 2566553, PMID 18793403
^ Wang, M; Ramos, BP (2007), "Alpha2A-adrenoceptors strengthen working memory networks by inhibiting cAMP-HCN channel signaling in prefrontal cortex", Cell 129 (2): 397–410, doi:10.1016/j.cell.2007.03.015, PMID 17448997
^ Jäkälä P; Riekkinen M; Sirviö J (May 1999), "Guanfacine, but not clonidine, improves planning and working memory performance in humans", Neuropsychopharmacology 20 (5): 460–70, doi:10.1016/S0893-133X(98)00127-4, PMID 10192826
^ Müller, U; Clark, L; Lam, ML; Moore, RM; Murphy, CL; Richmond, NK; Sandhu, RS; Wilkins, IA; Menon, DK; et al. (2005), "Lack of effects of guanfacine on executive and memory functions in healthy male volunteers", Psychopharmacology 182 (2): 205–13, doi:10.1007/s00213-005-0078-4, PMID 16078088.
^ McAllister TW; McDonald BC; Flashman LA (October 2011), "Alpha-2 adrenergic challenge with guanfacine one month after mild traumatic brain injury: altered working memory and BOLD response", Int J Psychophysiol 82 (1): 107–14, doi:10.1016/j.ijpsycho.2011.06.022, PMC 3210922, PMID 21767584
^ Singh-Curry V, Malhotra P, Farmer SF, Husain M; Malhotra; Farmer; Husain (June 2011), "Attention deficits following ADEM ameliorated by guanfacine", J. Neurol. Neurosurg. Psychiatr. 82 (6): 688–90, doi:10.1136/jnnp.2009.195792, PMC 3090126, PMID 20562462
^ Connor DF; Findling RL; Kollins SH (September 2010), "Effects of guanfacine extended release on oppositional symptoms in children aged 6-12 years with attention-deficit hyperactivity disorder and oppositional symptoms: a randomized, double-blind, placebo-controlled trial", CNS Drugs 24 (9): 755–68, doi:10.2165/11537790-000000000-00000, PMID 20806988
^ Jerie, P. (1980), "Clinical experience with guanfacine in long-term treatment of hypertension: Part II: adverse reactions to guanfacine", British Journal of Clinical Pharmacology 10 (Suppl 1): 157S–164S, doi:10.1111/j.1365-2125.1980.tb04924.x, PMC 1430125, PMID 6994770 .
^ Brain Res. 2004 Nov 19;1027(1-2):173-8. Noradrenergic alpha-2 agonists have anxiolytic-like actions on stress-related behavior and mesoprefrontal dopamine biochemistry. Morrow BA, George TP, Roth RH
^ Kozarlc-Kovaclc, D. (2008), "Psychopharmacotherapy of Posttraumatic Stress Disorder", Croatian Medical Journal 49 (4): 459–475, doi:10.3325/cmj.2008.4.459, PMC 2525822, PMID 18716993 .
^ Kaminer, D.; Seedat, S. & Stein, D. (2005), "Post-traumatic stress disorder in children", World Psychiatry 4 (2): 121–5, PMC 1414752, PMID 16633528 .
^ Neylan,, T.; Lenoci, M. & Samuelson, K. (2006), "No Improvement of Posttraumatic Stress Disorder Symptoms With Guanfacine Treatment", American Journal of Psychiatry 163 (12): 2186–2188, doi:10.1176/appi.ajp.163.12.2186, PMID 17151174
^ Sofuogul, M. & Sewell, A. (2009), "Norepinephrine and Stimulant Addiction", Addiction Biology 14 (2): 119–129, doi:10.1111/j.1369-1600.2008.00138.x, PMC 2657197, PMID 18811678
^ Kiechel, J. (1980), "Pharmacokinetics and metabolism of guanfacine in man: A review", British Journal of Clinical Pharmacology 10 (Suppl 1): 25S–32S, doi:10.1111/j.1365-2125.1980.tb04901.x, PMC 1430131, PMID 6994775 .
^ Kirch, W.; Kohler, H. & Braun, W. (1980), "Elimination of guanfacine in patients with normal and impaired renal function", British Journal of Clinical Pharmacology 10 (Suppl 1): 33S–35S, doi:10.1111/j.1365-2125.1980.tb04902.x, PMC 1430110, PMID 6994776 .
^ Ramos, Brian P.; Stark, David; Verduzco, Luis; van Dyck, Christopher H.; Arnsten, Amy F. T. (2006), "α2A-adrenoceptor stimulation improves prefrontal cortical regulation of behavior through inhibition of cAMP signaling in aging animals", Learning & Memory 13 (6): 770–6, doi:10.1101/lm.298006, PMC 1783631, PMID 17101879 .
^ Roth, BL; Driscol, J (12 January 2011), "PDSP K_i Database", Psychoactive Drug Screening Program (PDSP) (University of North Carolina at Chapel Hill and the United States National Institute of Mental Health), retrieved 15 November 2013
^ Xi-Ping Huang; Vincent Setola; Prem N. Yadav; John A. Allen; Sarah C. Rogan; Bonnie J. Hanson; Chetana Revankar; Matt Robers; Chris Doucette; Bryan L. Roth (29 June 2009), Parallel Functional Activity Profiling Reveals Valvulopathogens Are Potent 5-Hydroxytryptamine2B Receptor Agonists: Implications for Drug Safety Assessment, ASPET Journals, retrieved 1 January 2014 line feed character in |author= at position 15 (help)

External links

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UpToDate Contents

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1. 小児および思春期における注意欠陥多動性障害治療薬の薬理学 pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and adolescents
2. 成人の注意欠陥多動性障害（ADHD）に対する薬物療法 pharmacotherapy for adult attention deficit hyperactivity disorder
3. 小児および思春期における注意欠陥多動性障害：薬物治療 attention deficit hyperactivity disorder in children and adolescents treatment with medications
4. クロニジンおよびイミダゾリンによる中毒 clonidine and related imidazoline poisoning
5. 小児および思春期における自閉症スペクトラム障害：薬理学的介入 autism spectrum disorder in children and adolescents pharmacologic interventions

English Journal

Comparative efficacy of guanfacine extended release versus atomoxetine for the treatment of attention-deficit/hyperactivity disorder in children and adolescents: applying matching-adjusted indirect comparison methodology.

Sikirica V, Findling RL, Signorovitch J, Erder MH, Dammerman R, Hodgkins P, Lu M, Xie J, Wu EQ.SourceGlobal Health Economics and Outcomes Research, Shire Development LLC, 725 Chesterbrook Boulevard, Wayne, PA, 19087, USA, vsikirica@shire.com.
CNS drugs.CNS Drugs.2013 Nov;27(11):943-53. doi: 10.1007/s40263-013-0102-x.
BACKGROUND: No head-to-head clinical trials have been published comparing guanfacine extended release (GXR) and atomoxetine (ATX): two nonstimulants approved for the treatment of attention-deficit/hyperactivity disorder (ADHD). However, other study designs or methods could be used to indirectly comp
PMID 23975660

Guanfacine Extended Release: A Novel Treatment for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.

Faraone SV, McBurnett K, Sallee FR, Steeber J, López FA.SourceDepartment of Psychiatry and Behavioral Sciences, and Medical Genetics Research Center, SUNY Upstate Medical University, Syracuse, New York. Electronic address: sfaraone@childpsychresearch.org.
Clinical therapeutics.Clin Ther.2013 Oct 16. pii: S0149-2918(13)00952-1. doi: 10.1016/j.clinthera.2013.09.005. [Epub ahead of print]
BACKGROUND: Guanfacine extended release (GXR) has reported efficacy for the treatment of attention-deficit/hyperactivity disorder (ADHD) as monotherapy and adjunctive therapy to psychostimulant medications.OBJECTIVE: The objective of this article was to review the efficacy, safety profile, mechanism
PMID 24139092

Elevated Norepinephrine may be a Unifying Etiological Factor in the Abuse of a Broad Range of Substances: Alcohol, Nicotine, Marijuana, Heroin, Cocaine, and Caffeine.

Fitzgerald PJ.SourceDepartment of Psychology, Texas A&M University, College Station, TX.
Substance abuse : research and treatment.Subst Abuse.2013 Oct 13;7:171-183.
A wide range of commonly abused drugs have effects on the noradrenergic neurotransmitter system, including alterations during acute intoxication and chronic use of these drugs. It is not established, however, that individual differences in noradrenergic signaling, which may be present prior to use o
PMID 24151426

Japanese Journal

Central Sympathetic Inhibition Augments Sleep-Related Ultradian Rhythm of Parasympathetic Tone in Patients With Chronic Heart Failure

Yamazaki Tsugiyoshi,Asanoi Hidetsugu,Ueno Hiroshi,Yamada Kunihiro,Takagawa Junya,Kameyama Tomoki,Hirai Tadakazu,Ishizaka Shinji,Nozawa Takashi,Inoue Hiroshi
Circulation Journal 69(9), 1052-1056, 2005-08-20
… To assess autonomic sleep dynamics, the ultradian rhythm was extracted from all-night consecutive high-frequency (HF) components of heart rate variability (HRV) before and after administration of an α2-adrenergic agonist, guanfacine. … Guanfacine reduced blood pressure, heart rate, and plasma norepinephrine concentrations by 7%, 8%, and 34% (p<0.01), respectively. …
NAID 110002703838

PJ-037 Effects of a Central Sympathoinhibitory Drug, Guanfacine, on Cardiac Metaiodobenzylguanidine Scintigraphy in Patients with Heart Failure(Nuclear Cardiology 3 (I) : PJ7)(Poster Session (Japanese))

Igawa Akihiko,Nozawa Takashi,Matsuki Akira,Nakadate Teruo,Yamazaki Tsugiyoshi,Oda Yoshitaka,Igarashi Norio,Katoh Bunichi,Asanoi Hidetsugu,Seto Hikaru,Inoue Hiroshi
Circulation journal : official journal of the Japanese Circulation Society 68(Supplement_I), 488, 2004-03-01
NAID 110002701644

Related Pictures

★リンクテーブル★

リンク元	「グアンファシン」「グァンファシン」
拡張検索	「guanfacine hydrochloride」

「グアンファシン」

Guanfacine
Systematic (IUPAC) name
	N-(diaminomethylidene)-2-(2,6-dichlorophenyl)acetamide
Clinical data
Trade names	Afken, Estulic, Intuniv, Tenex
AHFS/Drugs.com	monograph
MedlinePlus	a601059
Licence data	US Daily Med:link
Pregnancy; category	US: B (No risk in non-human studies); ;
Legal status	US: ℞-only;
Routes of; administration	oral, intravenous
Pharmacokinetic data
Bioavailability	80-100% (IR), 58% (XR)
Protein binding	70%
Metabolism	CYP3A4
Biological half-life	IR: 10-17 hours; XR: 17 hours (10-30) in adults & adolescents and 14 hours in Paediatrics
Excretion	renal (80%; 50% [range: 40-75%] as unchanged drug)
Identifiers
CAS Number	29110-47-2
ATC code	C02AC02
PubChem	CID: 3519
IUPHAR/BPS	522
DrugBank	DB01018
ChemSpider	3399
UNII	30OMY4G3MK
KEGG	D08031
ChEMBL	CHEMBL862
Chemical data
Formula	C9H9Cl2N3O
Molecular mass	246.093 g/mol
	SMILES Clc1cccc(Cl)c1CC(=O)\N=C(/N)N ;
	InChI InChI=1S/C9H9Cl2N3O/c10-6-2-1-3-7(11)5(6)4-8(15)14-9(12)13/h1-3H,4H2,(H4,12,13,14,15) ; Key:INJOMKTZOLKMBF-UHFFFAOYSA-N ;
(what is this?) (verify)

　　[★]

英: guanfacine
化: 塩酸グアンファシン guanfacine hydrochloride guanfacine HCl
商: エスタリック, Tenex
関: グァンファシン

「グァンファシン」

　　[★]

英: guanfacine、guanfacine hydrochloride
関: グアンファシン、塩酸グアンファシン

「guanfacine hydrochloride」

　　[★]

塩酸グアンファシン

関: guanfacine

[DM-1] "Guanfacine (guanfacine) Tablet [Genpharm Inc.]". DailyMed. Genpharm Inc. March 2007. Retrieved 9 November 2013.

[MSR-2] ^ ^a ^b ^c ^d ^e ^f "guanfacine (Rx) - Intuniv, Tenex". Medscape Reference. WebMD. Retrieved 9 November 2013.

[3] Hofer, Kristi N.; Buck, Marcia L. (2008). "New Treatment Options for Attention-Deficit/Hyperactivity Disorder (ADHD): Part II. Guanfacine". Pediatric Pharmacotherapy (Medscape) (14): 4.

[4] Cruz, MP (Aug 2010). "Guanfacine Extended-Release Tablets (Intuniv), a Nonstimulant Selective Alpha(2A)-Adrenergic Receptor Agonist For Attention-Deficit/Hyperactivity Disorder.". P & T : a peer-reviewed journal for formulary management 35 (8): 448–51. PMC 2935643. PMID 20844694.

[5] raph

[Kolar-6] Kolar, Dusan; Keller, Amanda; Golfinopoulos, Maria; Cumyn, Lucy; Syer, Cassidy & Hechtman, Lily (2008), "Treatment of adults with attention-deficit/hyperactivity disorder", Neuropsychiatric Disease and Treatment 4 (2): 389–403, PMC 2518387, PMID 18728745 .

[7] Van Zwieten, P.; Thoolen, M. & Timmermans, P. (1983), "The pharmacology of centrally acting antihypertensive drugs", British Journal of Clinical Pharmacology 15 (Suppl 4): 455S–462S, doi:10.1111/j.1365-2125.1983.tb00311.x, PMC 1427667 .

[8] "FDA Approves Intuniv". Drugs.com. September 2009.

[9] "Shire submits INTUNIV® (guanfacine extended release) Marketing Authorisation Application to EMA". PharmiWeb.com. 3 April 2014.

[10] Jerie, P. (1980). "Clinical experience with guanfacine in long-term treatment of hypertension: Part I: efficacy and dosage". British Journal of Clinical Pharmacology 10 (Suppl 1): 37S–47S. doi:10.1111/j.1365-2125.1980.tb04903.x. PMC 1430120. PMID 6994777. .

[Effects-11] Kornfield R, Watson S, Higashi A, Dusetzina S, Conti R, Garfield R, Dorsey ER, Huskamp HA, Alexander GC; Watson; Higashi; Conti; Dusetzina; Garfield; Dorsey; Huskamp; Alexander (April 2013). "Impact of FDA Advisories on Pharmacologic Treatment of Attention Deficit Hyperactivity Disorder". Psychiatric Services 64 (4): 339–46. doi:10.1176/appi.ps.201200147. PMC 4023684. PMID 23318985.

[Arnsten-12] Arnsten AF (October 2010), "The use of α_2A adrenergic agonists for the treatment of attention-deficit/hyperactivity disorder", Expert Rev Neurother 10 (10): 1595–605, doi:10.1586/ern.10.133, PMC 3143019, PMID 20925474

[13] Zito, Julie M.; Derivan, Albert T.; Kratochvil, Christopher J.; Safer, DJ; et al. (2008), "Off-label psychopharmacologic prescribing for children: History supports close clinical monitoring", Child and Adolescent Psychiatry and Mental Health 2 (1): 24, doi:10.1186/1753-2000-2-24, PMC 2566553, PMID 18793403

[14] Wang, M; Ramos, BP (2007), "Alpha2A-adrenoceptors strengthen working memory networks by inhibiting cAMP-HCN channel signaling in prefrontal cortex", Cell 129 (2): 397–410, doi:10.1016/j.cell.2007.03.015, PMID 17448997

[15] Jäkälä P; Riekkinen M; Sirviö J (May 1999), "Guanfacine, but not clonidine, improves planning and working memory performance in humans", Neuropsychopharmacology 20 (5): 460–70, doi:10.1016/S0893-133X(98)00127-4, PMID 10192826

[16] Müller, U; Clark, L; Lam, ML; Moore, RM; Murphy, CL; Richmond, NK; Sandhu, RS; Wilkins, IA; Menon, DK; et al. (2005), "Lack of effects of guanfacine on executive and memory functions in healthy male volunteers", Psychopharmacology 182 (2): 205–13, doi:10.1007/s00213-005-0078-4, PMID 16078088.

[17] McAllister TW; McDonald BC; Flashman LA (October 2011), "Alpha-2 adrenergic challenge with guanfacine one month after mild traumatic brain injury: altered working memory and BOLD response", Int J Psychophysiol 82 (1): 107–14, doi:10.1016/j.ijpsycho.2011.06.022, PMC 3210922, PMID 21767584

[18] Singh-Curry V, Malhotra P, Farmer SF, Husain M; Malhotra; Farmer; Husain (June 2011), "Attention deficits following ADEM ameliorated by guanfacine", J. Neurol. Neurosurg. Psychiatr. 82 (6): 688–90, doi:10.1136/jnnp.2009.195792, PMC 3090126, PMID 20562462

[19] Connor DF; Findling RL; Kollins SH (September 2010), "Effects of guanfacine extended release on oppositional symptoms in children aged 6-12 years with attention-deficit hyperactivity disorder and oppositional symptoms: a randomized, double-blind, placebo-controlled trial", CNS Drugs 24 (9): 755–68, doi:10.2165/11537790-000000000-00000, PMID 20806988

[Jerie-20] Jerie, P. (1980), "Clinical experience with guanfacine in long-term treatment of hypertension: Part II: adverse reactions to guanfacine", British Journal of Clinical Pharmacology 10 (Suppl 1): 157S–164S, doi:10.1111/j.1365-2125.1980.tb04924.x, PMC 1430125, PMID 6994770 .

[21] Brain Res. 2004 Nov 19;1027(1-2):173-8. Noradrenergic alpha-2 agonists have anxiolytic-like actions on stress-related behavior and mesoprefrontal dopamine biochemistry. Morrow BA, George TP, Roth RH

[22] Kozarlc-Kovaclc, D. (2008), "Psychopharmacotherapy of Posttraumatic Stress Disorder", Croatian Medical Journal 49 (4): 459–475, doi:10.3325/cmj.2008.4.459, PMC 2525822, PMID 18716993 .

[23] Kaminer, D.; Seedat, S. & Stein, D. (2005), "Post-traumatic stress disorder in children", World Psychiatry 4 (2): 121–5, PMC 1414752, PMID 16633528 .

[24] Neylan,, T.; Lenoci, M. & Samuelson, K. (2006), "No Improvement of Posttraumatic Stress Disorder Symptoms With Guanfacine Treatment", American Journal of Psychiatry 163 (12): 2186–2188, doi:10.1176/appi.ajp.163.12.2186, PMID 17151174

[25] Sofuogul, M. & Sewell, A. (2009), "Norepinephrine and Stimulant Addiction", Addiction Biology 14 (2): 119–129, doi:10.1111/j.1369-1600.2008.00138.x, PMC 2657197, PMID 18811678

[Kiechel-26] Kiechel, J. (1980), "Pharmacokinetics and metabolism of guanfacine in man: A review", British Journal of Clinical Pharmacology 10 (Suppl 1): 25S–32S, doi:10.1111/j.1365-2125.1980.tb04901.x, PMC 1430131, PMID 6994775 .

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