Clonidine vs. guanfacine?

[jem83]

Hi, knowledgeable folks. I've posted here before about my 7-year old with ADHD, who is resistant to stimulants but has had some success on guanfacine 1mg twice a day (we tried extended release but found the IR to be more effective). His impulsivity is still a problem, though, and given his age and weight, our psychiatrist is reluctant to increase the dosage to 3mg/day. She suggested we might try clonidine instead. Does anyone have any experience to share with clonidine as a mono-treatment for ADHD, and/or with switching between clonidine and guanfacine? Thanks in advance!

[BoysMom4]

This sounds similar to my son (who is now 12 and no longer taking the Clonidine). He also was unable to take stimulants due to not tolerating the side effects (although just last week we reintroduced one with some success). He has been on 1 mg Guanfacine and also Zoloft for a while. At one point, for about year (probably around age 10) we added a small dose of Clonidine. It was somewhat effective for impulsivity BUT it knocked him out and made him so tired — he would pass out in the middle of homework etc. That was our experience. It worked but not well enough to balance out the side effect. Every kid responds differently to medication - and even the same kid may respond differently at different points in his development - so it’s definitely worth trying out.

[jem83 in reply to BoysMom4]

Thank you! This is helpful. Do you happen to recall how long you tried the clonidine before stopping?

[BoysMom4 in reply to jem83]

He was probably on it for a year?

[Hidden]

We haven’t ever been on Clonidine, only Guanfacine. Anecdotally, I hear about more success with Guanfacine (I am in a few ADHD parent groups)

[virgo02]

My 13 year old son takes 1 2.0 mg tablet every night for bed. He won't sleep otherwise. It's ridiculous 😒

[Onthemove1971]

Welcome. Just curious what "resistant to stimulants" means? Meaning you tried and nothing happened? We learned that there is a very wide range of dosing that a child can be given. Interesting enough, our son started on a high dose and we have not changed it at all. We also learned, it's not just about the dose but the timing. On the list some say their child is so much better on a short acting. Our son has been very successful on guanfacine on a 24 hour dose he takes at bed, he has issues with sleeping. He also takes Ritalin 2x daily extended release. With extended release the pill dispenses a short amount 3x's a day. Then a booster dose in the afternoon for homework/sports.

One last tip, we were also told that medication only takes care of about %60 of the symptoms and that is why thearpy helps most kids.

We have never tried clonidine, but I would try any recommendations his psychiatrist has to help him live a stable life.

Good luck,

[jem83 in reply to Onthemove1971]

We tried many different doses and forms of stimulants of both the amphetamine and methylphenidate types, and in all cases they caused awful rage with no apparent benefit. We had some success with guanfacine alone, but it just seems like he gets used to the dose eventually and it is no longer as effective. We might give a try to clonidine but I am worried about the sedating effect.

[Shontell]

Our 7 year old recently became resistant to jornay (24hr ritalin) and was switched to Adderall XL, he also has clonidine, guafacine, risperdal and a noon immediate release of ritalin. Im not understanding why his doctor wants to do on or the other.....be your child's advocate- you CAN change physicians.

[Aspen797]

Clonidine is more sedating in it's effect. Guanfacine improves working memory where clonidine does not. Both work better when combined with very low dose stimulants (the negatives of each are counteracted). We have also found sleep disruption to be a big factor in behavior. Guanfacine (maybe clonidine too?) above 1 mg can affect slow wave sleep meaning more night wakefulness. If you increased the guanfacine because the initial honeymoon period expired, but now have sleep issues and increasing behaviors, your doctor may want to consider decreasing the guanfacine a bit and adding a super low dose stimulant along with it.

[jem83 in reply to Aspen797]

I would just be concerned because he tried a low dose stimulants (and many doses/medications) but it just made him irate. It was awful. That is why we ended up just with guanfacine, but for a bit it was working wonders. Then the honeymoon period did indeed wear off. He hasn’t had worse sleep, but his impulsiveness is not under control. I was told that clonidine is stronger, but am worried that it will be more sedating...

[LuckyMonkey]

Our now 11 year old son had difficulty with stimulants, causing violent outbursts and meltdowns, but the Clonidine zonked him out.

We had a bit of trial and error trying to get it just right, but found by giving it to him about an hour before bed allowed for a nice bedtime transition and it helped quite a lot.

Sometimes you need to try it out, see how they tolerate it, trust your gut and advocate for your kid. Just because something works well in a trial or with other patients, doesn't mean its going to have the desired effect on your little one. Good luck!

[jem83 in reply to LuckyMonkey]

Thank you: very helpful! Can I ask if you also tried guanfacine at any point? And if so, was it more or less sedating for your son?

[LuckyMonkey in reply to jem83]

We have not tried guanfacine, no.