Guanfacine : Hi Everyone, My 9 year... - CHADD's ADHD Pare...

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BVBV profile image
42 Replies

Hi Everyone,

My 9 year old has been on Guanfacine ER since August. Prior to that he was unmedicated for 5 months and prior to that he was on stimulants for almost 2 years but he has to stop due to severe tics, not eating, and increased emotional/anger issues.

We are now seeing an increase of emotional behavior again. I cannot say that the guanfacine is responsible but I am thinking of working with his Neurologist to wean him off and see if there is any improvements or setbacks and go from there.

I’m curious if anyone has seen an increase in emotional behaviors with their children while on Guanfacine?

His main issues are impulsivity, hyperactivity, and lack of focus.

Thank you!

42 Replies
Pmommyof5 profile image


Two of my kids have taken Guanfacine for years son age 10( since age 6) and daughter age 12 (since age 8). They haven’t shown signs of this on Guanfacine but one of them had issues with emotional behavior regardless of medication she goes through periods of emotional behavior that increased in fall and spring more than I could manage and is now diagnosed as mood disorder by a psychiatrist who is also a neurologist. My other son is generally irritable as well when his medication wears off or he doesn’t sleep well.

Normally ADHD is tied with other diagnosis that they will not assess because of the age of the child.

We seeked therapy for my son and daughter to help them cope with their emotions because it’s hard on me as a parent. I also asked for therapy for myself to give me strategies to use to manage my well being as well.

I hope this helps.

BVBV profile image
BVBV in reply to Pmommyof5

Thank you for your insight. My son definitely has bigger emotions but it seems like his baseline is not as bad as it is now. It’s hard to know since there are so many variables.

NewbieParent profile image

What level of dosage is your kiddo on? My 9 year old son also started on 1mg (is that the min?) Guanfacine ER but it is only been 4 days so far. So far the only noticeable change is that he sleeps earlier and sometimes in car. I will keep an eye open for emotional issues over the next month and report back. Thank you for posting this thread.

BVBV profile image
BVBV in reply to NewbieParent

My son is on 2mg ER and takes it before bedtime. My son was also sleepy for the first couple weeks but that went away with time.

Squirrel14 profile image

The first medication we tried for our ADHD/ASD daughter was Guanfacine. She had a terrible response to it, flat affect, depressed, said she didn't want to be here. We took her off it immediately and moved to Focalin. A friend of mine with a son with a similar diagnosis just went through a similar situation with Guanfacine where her son became extremely sad. They just went off it too and his mood is much improved. Good luck, it's so tough to get the right med.

BVBV profile image
BVBV in reply to Squirrel14

Thanks for the reply. My son was also on Focalin for over a year but we had to stop because of side effects.

Pattimum profile image

We went straight from Methylphenidate (which was harming my son) to Atomoxetine. Guanfacine is a non stimulant like Atomoxetine and any non stimulant can be therapeutic or cause side effects which often will present as making ADHD behaviour even worse (mania etc). Look on medication leaflet which explains side effects. You should eventually be able to find a non stimulant that works for your child. Unlike different stimulants which really are very similar, non stimulants are all very different to each other. Maybe Qelbree would work better for your son? Atomoxetine works very well for my son- he stopped having tics, his mood is better, he can sleep and he can eat and he is not as oppositional at home (at school he was always fine- just not focused, but now even at home he does his homework with fewer outbursts and objections) . I was worried that he would still have appetite suppression but he’s fine. If you are worried about your child’s appetite, many parents here on this forum recommend Periactin so you could ask your doctor about it.

BVBV profile image
BVBV in reply to Pattimum

Thanks for your reply. I’m going to research Qelbree.

StellarMom profile image

My older 8 yr old takes 1 mg of Guanfacine with 25 mg of Zoloft. He started the Zoloft first and it has been working well. My younger son (7) tried Guanfacine before getting on Zoloft & it was a disaster. He had a huge anger outburst & even hit his teacher. So he only tried that for one or two days. My younger son is on Strattera for ODD/ADHD along with Zoloft & that has been helping. Strattera is a good non stimulant option that helps with anxiety & anger/defiance.

BVBV profile image
BVBV in reply to StellarMom

Thanks for that information. Can I ask what benefits you’re seeing on Zoloft?

StellarMom profile image
StellarMom in reply to BVBV

They started immediately for my older son. The extreme meltdowns stopped. This year he couldn’t get out of bed to go to school & again, a small adjustment in the dosage gave him the ability to get up & do well in school. My psychiatrist was correct that in managing the anxiety first the other issues would be easier to tackle. My son still struggles to manage his frustration, but he’s gaining skills as he matures & the school is working with him.

ELucas13 profile image

Guanfacine was a game changer for us. Guanfacine alone is helpful, but we had to add something else to get real success. We added Vyvanse. We only had negative side effects at the very beginning of Guanfacine and that was extreme fatigue. Every child is different and each parent here will have their own stories to share, but for us, when nothing else had worked, it was life altering in a good way.

It sounds to me like your child may need to add something to the Guanfacine or you can also try to increase the Guanfacine. We tried increasing Guanfacine from 2mg but it didn't do anything so we went back to his normal dosage.

BVBV profile image
BVBV in reply to ELucas13

Thank you for your reply. My son did try stimulants for awhile, including Vyvanse. I do agree either his dosage is wrong or he needs something else.

anirush profile image

My teenagers are both on Guanfacine but as an additive. One is also on Welbutrin the other on Straterra.No one medication was able to keep them stable but Guanfacine was a wonderful addition.

BVBV profile image
BVBV in reply to anirush

Does one of your sons take both guanfacine and strattera together?

anirush profile image
anirush in reply to BVBV


Team27 profile image

We found that the combination of Guanfacine and stimulants worked best for our son. The stimulants alone made him aggressive and emotional. The Guanfacine alone didn’t help with his impulsivity and focus. But when we combined the two, we saw great results.

BVBV profile image
BVBV in reply to Team27

Thank you!

Elijah1 profile image

Some children get irritable on guanfacine but the only way to tell if it is the reason is to stop it. Also make sure that the unwanted behavior isn't caused by guanfacine making him tired.

BVBV profile image
BVBV in reply to Elijah1

Thank you! I agree his baseline of emotions was not this bad when he had a long meditation break so I’m thinking of seeing if there are any improvements if he weans off and make a determination on where to go next.

Lanego profile image

My son started on 1mg ER(the lowest dose) and after a couple months it was increased to 2mg. It has greatly improved his impulsivity and outbursts, and he is able to focus more at school and take time with his homework.

BVBV profile image
BVBV in reply to Lanego

I’m so glad you’re seeing good improvements!

My son has a drowsiness side affect to this medications. I'm switching it to Vyvanse 20 mg, hope it works.

BVBV profile image

My son takes guanfacine at night so we haven’t noticed sleepiness during the day. I hope Vyvanse works well for your son!

Kkoelle profile image

hi I can totally relate, my son had developed tics with stimulants so we changed to only guanfacine, however this didn’t help his outbursts. The tics went away though. So his doc put him in stimulant in AM and guanfacine after school. They balanced each other out pretty well.

BVBV profile image
BVBV in reply to Kkoelle

Thank you for your reply! My son also developed severe tics on stimulants along with other side effects but I am going to keep that in mind.

SanityCoaching profile image

My 14yr old just Started Guanfacine a little over a month ago. The doctors told us it would help with impulse control. Last week I told the DR that it wasn't working because her impulsivity and anger outbursts we as strong as over, so they upped the dosage. Last night she flew into an uncontrollable rage over the smallest thing. I was wondering if it was the Guanfacine, now hearing all your comments, I'm pretty sure it is and am going to ask if we can switch to something else.

BVBV profile image
BVBV in reply to SanityCoaching

I know there are so many variables, school, time of year, ect but it definitely seems like my son’s way more emotional since starting as well. I am leaning towards weaning him off to see if the guanfacine is at all responsible. This medication journey is so hard!

Bootsie1 profile image

For my 13 now 15 yo daughter stimulants worsened her ADHD symptoms... We tried them all in every dose available.

We then moved on to Guanfacine ER, which worked amazingly well for the first month or so. After which, the moods/impulsivity slowly returned, so we then would raise the dosage and this cycle went on for quite some time.

From what I understand, the initial improvement of her symptoms can be attributed to Guanfacine’s initial post-synaptic effects on norepinephrine. Basically, at first, NE is reduced but as the medication is continued, let's say 5/6 weeks or so, the medication strengthens the connections in the prefrontal cortex and therefore strengthens neurotransmission of dopamine and NE.

Although the initial effect of dampening NE helped improve my daughter's symptoms, the strengthening of the PFC connection was not mimics what stimulants do.

Finally, her psychiatrist prescribed Clonidine ER and it has been working quite well for her. Clonidine works both pre synaptically and post-synaptically to reduce NE without strengthening neurotransmission secondarily.

With all that said, and I know that was a mouthful... this was my daughter's personal experience and what was helpful for her. We just have to keep up the good fight when our mommy/daddy instincts tell us something is not quite right or could be better. Best of luck!

BVBV profile image
BVBV in reply to Bootsie1

Wow, thank you for all that background information! That’s how I feel, he did good the first month and then it’s gotten worse and I hesitate just continuing to up his dosage. I actually wanted to try Chlonidine first but his Neurologist wanted him to start on Guanfacine. What time of day does your daughter take Chlonidine ER?

Bootsie1 profile image
Bootsie1 in reply to BVBV

Funny, same here. I initially expressed interest in Clonidine however her psychiatrist strongly suggested Guanfacine ER over the Clonidine 😕

She takes it once per day around 8:30 pm. It doesn’t “knock her out” either…. she doesn’t go to bed till 10:30ish

We may try increasing the dose at her next visit just to make sure 0.1mg is the optimal dose for her.

BVBV profile image
BVBV in reply to Bootsie1

Interesting, I’m definitely going to inquire again about chlonidine. Do you notice it helps her during the day?

JJMom16 profile image
JJMom16 in reply to Bootsie1

Thank you for sharing. This is SO incredibly helpful for me to read! We are 6 weeks into Guanfacine ER 1mg. The first two weeks were amazing, and now, the Irritability/Anger/Outbursts are worse than before. Your description makes so much sense. What was the process of coming off of Guanfacine like? We are on day 1 without it.

BVBV profile image
BVBV in reply to JJMom16

So we haven’t actually started to wean him off yet as I’m still waiting to connect with his Neurologist first. I’m going to tell him that’s what I want to do and I’m worried he’s going to want to increase the dosage, but I really think it’s contributing to emotional behavior. Will you let me know how the process goes for you? My son can’t go back on stimulants so we would need to try chlonidine, which I wanted to try originally, or another non-stimulant.

JJMom16 profile image
JJMom16 in reply to BVBV

I will keep you posted. Bootsie1 , how did the transition off of Guanfacine ER go for you?

Bootsie1 profile image
Bootsie1 in reply to JJMom16

We didn't see any negative or rebound behaviors once we stopped. She was on the lowest dose (1mg ER) so that may be why. What I did see was a return to less intense mood state.

The clonidine is still working very well and her general mood is greatly improved.

I am planning to ask her doc at the next appointment if maybe a low dose stimulant (and I mean super low-like cutting lowest prescribable dose in half) could be added. Mainly bc although she is in a better place in respect to her mood, I still observe some risk-taking and impulsivity. Then again, it may just be age-appropriate teen behavior. The nice part about stimulants, is what you see, is what you get and I will know very quickly if it Is having a negative impact like in the past.

JJMom16 profile image
JJMom16 in reply to Bootsie1

Bootsie1 did you notice the return to the less intense moods immediately after stopping, or did it take some time? I ask because Guanfacine seems to take a few weeks to build up to its full effect for ADHD, and I am wondering if it will take time to fully leave the system. This is super confusing to me because the half life is supposed to be ~17 hours. We are on day 2 off of 1mg Guanfacine ER, and I'm trying to figure out when we'll see the full "off" difference.

Bootsie1 profile image
Bootsie1 in reply to JJMom16

within 2/3 days she was much improved. Each person metabolizes medication differently so I would guess it varies based on the individual

Bootsie1 profile image

I definitely see an improvement during the daytime. Her mood is lighter and upbeat.

For example, she is more open to conversation and lite chitchat…less apt to impulsively snap at us. And another positive is that she’s been keeping her room clean and showing an interest in decorating it nicely. When I see her behaving this way, I know she is feeling less overwhelm and exhaustion:)

PS To be clear, she is taking the extended release Clonidine. I know I referred to it a few times as Clonidine without mention of the ER … just fyi

Imakecutebabies profile image

My son started on guanfacine in July and we upped the dose in August, and since then he was doing really well... But I've noticed his impulsivity starting to increase again now. I'd say it's still below his baseline from before meds, but it's starting to have an effect on daily life again. I've been hesitating to bring it up because I'm afraid it will lead to a cycle of upping his dosage every couple months, which isn't sustainable... But now I'm wondering if maybe it's just the wrong medication. But the effects since starting it have been so much improved that I'm loath to start experimenting with other things...

No My son was just falling asleep at school otherwise it was just useless

yeller profile image

My 14 year old daughter has taken Guanfacine at night for years. She went off it for a short spell, but she resumed because of emotional outbursts. She is also on Vyvanse in the AM, and an antidepressant, for her ADHD. The meds help, but we ended up going to wilderness therapy for the summer where she learned a lot about the root of her issues with friendships and self esteem; she learned strategies for coping. Wilderness was a life changing experience for her. She is no longer depressed and anxious and is making friends at a new school. thanks (Yeller stands for Old Yeller, the dog. I try not to yell)

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