Guanfacine IR vs XR

[elizabethspencer416]

I have a 5-year-old son with severe ADHD and ODD. We started our journey with medicines about a year ago.

We started with Ritalin and Adderall, both of which gave him extreme rage issues. Our doctor suggested we switch to Guanfacine immediate-release. He is currently on 2mg in the mornings, working our way up slowly over the last 4 months or so. We have noticed some improvements with his impulsivity and behavior, but he crashes HARD in the middle of the day, and he doesn't sleep well at night anymore.

Has anyone had any experience switching the ER version of Guanfacine, and having their child take it at night?

His teacher has told us that he is borderline manic in the mornings until about 9am, and then he crashes around 11am.

[Mama808]

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first your doing a great job. Does he have an IEP? Do they have supports in place at school. My little guy would have massive behavior issues one of the reason was because staff was irritable with him which made him feel miserable, he felt like he had nobody he could trust. It was a long battle. Please keep documents and seek outside help to guide you. Please know your rights and remember they need to accommodate his needs not you accommodate their needs & wants. Keep positive, sending live and light God

[elizabethspencer416 in reply to Mama808]

He is currently in a private school, with plans to move him to public school next year when he starts kindergarten. I have reached out about an IEP, but the two districts that we are close to would not start the evaluation process until he's physically in the classroom. He has been seeing a psychotherapist weekly for about two years now.

[ELucas13]

We had similar reactions to adderall and ritalin. Gaunfacine ER was a game changer for us. It builds up in the system and I there isn't supposed to be any crash. It isn't like stimulants when it is in the system and then out. It's in there and you titrate up or down as necessary and slowly. Start at night if it makes him tired. Once he gets used to it, he can take it in the morning.

We tried Vyvanse in conjunction with the Guanfacine. Now we have a new kid! It's been amazing. Wellburtrin may also be another you could try. Stimulants and non-stimulants can be a good marriage of ADHD medicines.

[Lahavre in reply to ELucas13]

My son is 8yrs old . With autism and severe ADHD Vyvanse in conjunction with the Guanfacine has changed our life’s . He’s a different kid. We happy with the results.

[elizabethspencer416 in reply to ELucas13]

He is currently taking his 2mg IR guanfacine in the mornings. We are switching him to the 2mg ER at night.

[Imakecutebabies]

My 6yo son takes 2mg of guanfacine ER right school. We were giving it to him at bedtime but then he couldn't sleep and would be up late and then tired the next day. Giving it with after school snack means now he's asleep by 8:30. It stays in the system so it never wears off, which is good--but make sure you don't miss a dose or it can mess with his blood pressure and heart.

[Aspen797]

Hello and welcome to the group! Our 14 year old takes 1mg extended release in the morning and 1mg extended release in the evening. It took a very long time (a year of titration) to work up to two mg because of night waking. Guanfacine above 1mg/day is known to interfere with sleep. With a very slow build up his night waking is very minimal now. If it wasn’t for our son’s increasing tics—which guanfacine also helps with—we would have stuck with 1mg.

If you aren’t already, consider seeing a child psychiatrist or developmental behavioral pediatrician. They have more experience with these medications.

Five is such a hard age because any lack of sleep really affects behavior. So while guanfacine may help, it’s really critical to keep it at low enough of a dose that sleep isn’t effected.

I saw you mention that the school districts nearest you declined to evaluate. Under child find, they are legally obligated to. You might want to get in touch with your state’s parent resource center for more info/referrals. Find yours here: parentcenterhub.org/find-yo.... Getting an OT eval might also help start a helpful paper trail for kinder and may help address sensory issues causing anxiety and/or emotional regulation issues causing problems.

[RelaxingDays]

My 8yr old is on the 3mg ER, Vyvanse and other meds to help ADHD/impulsive behaviors/anxiety/sleep. I agree with having a good child psychiatrist (ours makes very small med changes and only 1 change at a time to know whether or not it is helping). Also, group therapy for kids can be helpful. As for IEP evaluation, we had similar issue. So we switched our child into public school preschool in middle of year for an evaluation to be considered. A long process. It's been 3 years of new doctors, therapists, med changes, school meetings, trying different supports at home and school...lots of ups and downs but we're finally seeing a great school year so far. There will always be changes and adjustments especially because every child is different and their bodies are growing. Keep asking questions and following up with doctors and therapists. Hope this is helpful.

[Lanego]

we started our son at night and it has been effective. We use 1 mg ER and now he’s on 2mg.

[BVBV]

My son couldn’t tolerate stimulants so he is now taking 2mg Guanfacine ER prior to bedtime. He’s very hyperactive and impulsive and we may need to titrate up in dosage, however, I haven’t noticed any sleep issues aside from the first week where he woke earlier than normal.