Guanfacine causing nightmares and increased daytime anxiety?

[SurvivorFan]

Hello, my son (6) recently started Guanfacine. He has been taking 1mg at night and .5mg in the mornings. He is also on Ritalin. The reason we started guanfacine was to hopefully cover the areas of time where stimulant has worn off (morning and early evening) as well as to help some with impulsivity/emotional deregulation. He is already taking a short acting stimulant in the afternoon but he metabolizes fast.

He started the new med 4 nights ago. Behavior has been good to the point he didnt have his afternoon stimulant the past 2 days and was fine. Fell asleep really quickly at night. We have noticed a HUGE jump in his anxiety however. He was fearful of bugs before but he had a full blown panic attack and other huge reactions due to a fly in the house.

Lastnight he woke at midnight terrified that he saw a pirate in the bedroom. After getting him back to sleep he woke several other times claiming he heard a squeaking noise. There was none.

Is this just a coincidence or is this guanfacine related?? I'm exhausted and frustrated and heartbroken that this is going this way.

We are in the process of finding a pediatric psychiatrist. He currently sees a neurologist.

[Onthemove1971]

I am not sure how long the Guanfacine is suppose to last. But could you move it to the morning? Of course speak to the doctor first. If you are using it yo help with sleep, this is not a solution..You might also just wait and not make any change and se if things improve in a few weeks.

The question is what is normal development and what is due to the medication?

Yes, I agree a child psychiatrist would really help. But until you see them do what you can. It is great that it is summe and it's not impacting school.

Our Guanfacine is a 24 hour so moving it for us would be ok.

Just know in a few years when I all of this is dialed it life will become much more "normal".

Good luck!

[SurvivorFan in reply to Onthemove1971]

The neurologist wanted to do 1mg at night for sleep as well as cover morning hours. Then a small does in am (work up to more) to cover early evening time when ritalin has worn off. They are both 12hr tabs. If it were symptoms such as dry mouth, slight increase in irritability or what not than I can see sticking it out a few weeks but this sudden huge increase in fear is hard to swallow. Yes good its in summer but also worst time. He is terrified to be outside. Before when he saw a fly he would get the swatter or a pillow. This was a panic attack.

It is so discouraging since it seemed to be helping with impulsiveness.

I wish it was not such a guessing game with all of these meds.

[Blue_Mouse]

We saw much less anxiety with guanfacine. In fact, when we tried ritalin the irritability and behavior got worse, so we reinstated guanfacine and are sticking with it.

Given the nature of guanfacine itself, my thought is that the change you're seeing is unrelated, but the psychiatrist will be able to help you.

[SurvivorFan in reply to Blue_Mouse]

We tried 1/2 tab lastnight and he slept through the night/no nightmares. Woke up in good relaxed mood. Going to try and titrate a bit slower and see how it goes.

[Hidden]

Guanfacine can cause night terrors unfortunately. I give 2 short acting doses- one as soon as he wakes, and another after lunch. By bedtime the med has worn off and he sleeps without issues.

[SurvivorFan in reply to Hidden]

I did not know that was an option. Good to know.

[Hidden in reply to SurvivorFan]

It sounds like you are on the short acting dose, however the med doesn’t necessarily last 12hrs. Everyone metabolizes it at a different speed. Through experience I found the med left my sons system after about 6-7 hrs. That’s why I can fit two doses during the day.

[SurvivorFan in reply to Hidden]

That makes sense. The extended release ritalin only lasts around 8hrs for my kiddo so we give a short acting in the afternoon to last us until 6ish.

[olaughll]

My 7 year old grandson who lives with me sees a psychiatric NP and psychology therapist. He reacted we tried 2 different stimulant medications and he reacted horribly with rage and anger. He is now up to 3 mg of guanfacine at night along with Sertraline 25mg in the morning. He does get frightened at night and come to bed with us, but, I don't think it is more often than before the medication. He no longer rages and there is much improvement in his patience and impulse control with this combination. The down side is that the quanfacine can cause orthostatic hypotension and caused him to get dizzy and affect his vision when rising too fast. This has improved.

[TruSoma8]

Hi we found it better to give in morning and at night we do clonidine to help with sleep. I find guanfacine kept him awake. Hope this helps

[SurvivorFan in reply to TruSoma8]

Thank you it does help to hear others expierences with it!

[MustangGma]

Hi. We are giving our (Fasd, adhd, odd, spd) granddaughter 1 mg guanfacine ER in the morning and 1 mg late afternoon. And yes, night terrors. However, it's been a month now with the added afternoon dose and I think the terrors are starting to wane. Her behavior has been wonderful just this past week so hoping for the best here. Maybe give it more time? Supposedly guanfacine takes a while to level out and see the full effects. Hoping for the best for all of us in this!

[SurvivorFan in reply to MustangGma]

Thanks for the reply. I am hoping going up at a slower rate will help. Will try bumping back up to 1mg in another week so that we have a good baseline for what .5mg is doing/not doing for him.

[BigBrotherFanatic]

Okay I hope you actually see this but did you ever figure out the right medications?! I have an emergency appt with our psych tomorrow because of the night terrors she had while on the guanfacine, then we discontinued and now she has become so physically violent and out of control. She was historically on clonidine because she has ASD, ADHD, and TTM (obsessive hair pulling disorder). We had to switch from clonidine to sertraline because clonidine was giving her night terrors. This was 2 years ago. The guanfacine was started a few weeks ago. We were hoping that we would see a difference in the constant waking up (side note - she is on 75 mg of trazodone at night, and the 2 guanfacine were at 6 am and 12 pm. ). Now we’re on day 2 of discontinuing and her 75mg of traz isn’t doing ANYTHING. She got it at 7:30 last night and wasn’t asleep until 2 am 😳

Please tell me you found something that worked?!

[SurvivorFan in reply to BigBrotherFanatic]

Hi! So sorry your all going through a hard time right now. I know how exhausting it is emotionally and physically.Quite a lot has changed since I wrote this original post but will try and keep it short!

My son (8 now) has adhd and generalized anxiety. It's possible that the guanfacine caused his original nightmares or it could have been anxiety related. We titrated up slowly on the guanfacine but for as long as I can remember he has been on 2mg of guanfacine in the morning and then 2mg again in the late afternoon. We recently discovered that WiTHOUT the guanfacine (husband forgot to give it to him twice while I was gone) he would not go to sleep. Like at all. Up until 4am extremely high energy/obnoxious before crashing for 1hr. I'm actually kinda glad it happened because I was wondering if he needed it anymore!

He now takes Focalin XR twice a day 7am and 12pm which gives us coverage stimulant wise until about 6pm. He also takes Concerta for his anxiety/mood disorder. Each of his medications plays a vital role for him. When the anxiety medication wasn't working for him complete blow ups and melt downs over tiny things. When the stimulant and guanfacine wasn't right really dysregulated and hard to be around. Currently all are working well for him and 2nd grade is going great. We still have some rough times don't get me wrong but overall pretty good. Finding the right medications and doing the correct parent training (shout out to adhd dude parent training) is so important and unfortunately not easy! We have had to do a lot of trial and error and tweaking and I know in the future there will be more. All we can do is keep advocating for our kiddos and know you are not alone. I hope you get some answers and relief tomorrow with a plan to help your kiddo at your appointment! Listen to your gut, write down your questions and journal everything so you can go back and see what did and didn't work.

Quick add- I just remembered as I was reading back why his anxiety sky rocketed during that time. We figured out it was the long acting Ritalin. Once we took him off of that the next day the extreme fears disappeared. On Focalin XR he does not have that issue.