PRESCRIBING INFORMATION
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
How guanfacine affects HCN channels2
Guanfacine can modulate synaptic transmission in the pre-frontal cortex according to the following post-synaptic effect:
HCN channels are opened in the presence of cAMP, and the resulting current ‘shunts’ synaptic input. Stimulation of α2A-adrenergic receptors by guanfacine reduces cAMP production, closing HCN channels and increases the efficacy of synaptic transmission.2
Adapted from Wang et al. 20072
The images above do not depict actual tablet size.1
Once daily flexible dosing: morning or evening1,3
| Starting dose | Dose adjustment | Maximum dose | Maintenance dose |
|---|---|---|---|
| All patients (monotherapy/ adjunctive) 1 mg once daily (swallowed whole)1 |
Increments up to 1 mg/week1 | 4 mg/day for children (6-12 years), 7 mg/day for adolescents (13-17 years)1 |
0.05-0.12 mg/kg/day1 |
INTUNIV should be titrated gradually based on clinical response and tolerability1
| Weight | Target dose range (0.05-0.12 mg/kg/day) |
|---|---|
| 25.0-33.9 kg | 2-3 mg/day |
| 34.0-41.4 kg | 2-4 mg/day |
| 41.5-49.4 kg | 3-5 mg/day |
| 49.5-58.4 kg | 3-6 mg/day |
| 58.5-91.0 kg | 4-7 mg/day |
| ≥91.0 kg | 5-7 mg/day |
|
Doses above 4 mg/day have not been evaluated in children (6-12 years) and doses above 7 mg/day have not been evaluated in adolescents (13-17 years)1
|
Downward titration and discontinuation1
-
Patients/caregivers should be instructed not to discontinue INTUNIV without consulting their physician.
-
Blood pressure and pulse should be monitored when reducing the dose or discontinuing INTUNIV.
-
Total daily dose should be tapered in decrements of no more than 1 mg every 3-7 days to minimise the risk of an increase in blood pressure upon discontinuation.
-
Tapering INTUNIV dosing during withdrawal is recommended to minimise these potential withdrawal effects.
Missed doses1
-
In the event of a missed dose, INTUNIV dosing can resume the next day.
-
If 2 or more consecutive doses are missed, re-titration is recommended based on patient tolerability to INTUNIV.
Sub-optimal responders to psychostimulants1
INTUNIV may be co-administered with psychostimulants in patients in whom psychostimulants alone have not provided an adequate response.
-
Recommended maintenance dose for INTUNIV when co-administered with psychostimulants is within the range of 1-4 mg/day, depending on clinical response and tolerability.
-
Doses above 4 mg/day have not been evaluated in co-administration trials.
PBS Information: This product is listed on the PBS. Authority required. Refer to PBS Schedule for full authority information.
Click here to review full approved Product Information before prescribing.
REFERENCES
- INTUNIV® (guanfacine hydrochloride) Approved Product Information.
- Wang M et al. Cell 2007;129:397-410.
- Newcorn JH et al. J Am Acad Child Adolesc Psychiatry 2013:52:921-930.
REFERENCES
- INTUNIV® (guanfacine hydrochloride) Approved Product Information.
- Wang M et al. Cell 2007;129:397-410.
- Newcorn JH et al. J Am Acad Child Adolesc Psychiatry 2013:52:921-930.