Hello,
Wondering from this community if you've seen a correlation between Guanfacine and night terrors/ nightmares?
My son is on week 2 day 6 of an increased dose (2mg ER, up from 1mg). It's causing tiredness and sleep disturbances. Most concerning is him being scared to go to sleep or waking up from nightmares. There's some positives happening too so I'm hesitant to jump ship since we're still in the trial period but also don't want his sleep or fears to be getting worse.
Is he on any other medication? This happened to my son but we had started Adderall at the same time. We should not have started two new meds at the same time (we had a terrible psychiatrist at the time), however, I'm convinced that the guanfacine ER was causing the night terrors, he would wake up 1/2 hours after going to bed and it was terrifying, screaming, seeing things, spiders, weird things). We tried it for 2 weeks and stopped everything. We removed all medication for 4 months (this was the end of a year long trial with stimulants all of which didn't help). We have since introduced immediate release guanfacine (Tenex) in September. I was SO nervous to start up again. However, it has worked so well! We started with .5mg at night for 2 weeks, then added .5mg in the morning. After 6 weeks, we upped it to 1mg evening and then after 2 weeks, 1mg morning as well. I've read so many posts, and it seems some kids don't do well on ER but can do IR. You may ask your doctor about this.
My son who is 6 has been on ER Guanfacine since March 2022 and he's at 1mg in the AM and 1mg in evening and since the Summer he has been having issues with sleep similar to what you are describing. And it's getting worse. We added to this adderall 2 weeks ago in addition to the guanfacine ER and now we are seeing more aggression at school. We will be taking him off Adderall and trying another stimulant and will switch to Clonodine in evening to see if that helps him sleep. We think the lack of sleep over last few months is also adding to his irritability in the day at school. It's a rough process. It's just interesting b/c first 3-4 months on just the guanfacine he was fine...but maybe his body is metabolizing it differently causing these effects. If you feel like it's too much definitely let the doctor know or try the Instant Release as amewhit recommended above. Sending good vibes...this medication trial and error is tiring for sure
Hi there. Sorry to hear that your child is experiencing nightmares. My son has been taking guanfacine for several years and he did initially have nightmares when he started taking the medicine. He also had an uptick in nightmares when we increased his dose. Both times the nightmares resolved. I can’t remember how long it took- maybe a few weeks.
Hi, my then 7 year old started this journey first with Guanfacine too - we were so impressed and happy with the daytime results, but over the course of a month of tying it, he had 3 unpredictable episodes of unbelievably bad night terrors. Our prescribing psychiatrist was kind of stumped and had not seen that before - in fact it was what sent me to join this group. So in support for you I wanted to tell you that YES, nightmares are definitely a side effect that is perhaps more common than we know, and I stuck with it for a while because the positives were so positive for him at school and mood at home - but ultimately I realized he couldn't do sleepovers or go to camp that summer (as we had planned and paid for) because we just didn't know when he would have one of the really bad nightmares. I'm talking like more than terrors or a bad dream - it seemed to me sitting with him on the floor holding him that it was more like hallucinations.
Ultimately we tried other options, and have found our groove with zoloft and vyvanse.
I know each kiddo is different and will go down a unique path, but I support you and I know how hard and horrible it is when they have the nightmares related to Guanfacine. Wishing you peace and love, and you are not alone.
Thanks, all. My son was diagnosed in April and since summer he'd been on 1mg of Guanfacine. We added trials of Quillivant, Ritalin and Adderall to the Guanfacine and none were the right thing for him. Behavior was worse and he was so irritable on the meds. I appreciate your experiences with Guanfacine. @ColoradoMom I completely relate to your story. Last night my son was up again, having had a horrible nightmare and then telling me he kept seeing the walls turning red in the room. He's had periodic fears in the past but I could tell on this med his fears were much more intense and vivid and possibly veering into hallucinations. I took him back down to 1mg this morning. I don't think he's supposed to go off Guanfacine all together all at once but needs to taper down? Not sure. I emailed his medication manager yesterday. She normally gets back to me right away but still waiting to hear. Heartbroken that my kid has gone through this and doesn't fully get why and that we are still in the same place we started with not finding a fit on meds for him. It's so tough.
I kind of remember that we didn't taper down, we just stopped, but I don't remember what dose we got up to - I hope your med manager responds quickly. But now that we've found something that does work, I don't regret going off guanfacine. We've found the same daytime successful results with other options. My husband is ADHD and in the 80s he was given some kind of stimulant (probably Adderall) and hated how he felt on a stimulant, so for about a year we were trying to find an alternative non-stimulant. I have a hunch that what he was given so many decades ago was probably way too high, and today we have sooooo many more options, and so much more research and information. Finally my husband agreed to try some stimulants - after a few trials of different molecules, it was like a light switch when we got our son on Vyvanse. It really is such a chemistry experiment, and feels horrible as the parent trying so many different things with your kid "like a guinea pig" but don't give up.
Also, just like all facets of parenting, right when you think you've found the magic combination and hit your stride - he has an outburst or depressive moment that breaks my heart. Then you tinker with increasing one or the other, waiting to see what works or doesn't - but I do recommend this podcast with Dr. Koplewicz (on the Dax Shepherd Armchair Expert) armchairexpertpod.com/pods/.... It helped me feel less guilty about medication altogether, and that we are doing this because we love them so much, and want to help them be the best version of themselves that they can grow up to be. Combined with therapy and working on consistent supportive language at home. Not waiting until they are older and hormones have come online as well, complicating all the feelings and emotions. The younger we medicate, the sooner they can feel what it's like to be successful - at school, at home, with friends - then eventually taper off - or allow them to choose when the need or want to medicate (like in college to help study for exams, but perhaps not always)...
Truly wishing you a quicker path to the answers, and know that there is light at the end of the tunnel.
Adderal XR and Guanfacine
non stimulant trial with guanfacine
Adderall and Guanfacine side effects with sleeping 
Guanfacine and aggression
Guanfacine and irritability
