How to Select Adults With ADHD for Guanfacine Extended-Release
Which adults with attention-deficit/hyperactivity disorder fit the patient profile studied for guanfacine extended-release treatment?
Adults with attention-deficit/hyperactivity disorder often have psychiatric and medical comorbidities that complicate medication choice. This guide helps clinicians identify whether a patient resembles the relatively uncomplicated adult ADHD population in whom guanfacine extended-release was studied.
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Confirm adult ADHD and baseline symptom severity
Identify adults aged 18 years or older with a current DSM-5 diagnosis of attention-deficit/hyperactivity disorder. In the study, eligible patients also had an ADHD-RS-IV total score of 24 or higher and a Clinical Global Impression-Severity score of 4 or higher at baseline.
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Exclude major psychiatric comorbidity requiring treatment
Do not assume these results apply to adults with schizophrenia, bipolar disorder, personality disorder, or mental retardation, because these diagnoses were excluded. Patients were also excluded if they had a documented moderate or severe psychiatric disorder necessitating treatment, excluding counseling, or documented DSM-5-defined anxiety or depression.
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Screen for substance use, seizure, tic, and suicide risk exclusions
The study excluded adults with a history of DSM-5-defined substance use disorder or seizures. It also excluded patients with a serious tic disorder, including DSM-5-defined Tourette disorder, and those considered at suicide risk.
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Assess cardiovascular suitability before treatment
Check for evidence or history of cardiovascular disease before applying this trial's findings. Excluded patients included those with QTc greater than 450 msec using Fridericia correction, orthostatic hypotension, continuous bradycardia, or abnormal electrocardiogram or laboratory values at screening.
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Review concomitant medications that affect hemodynamics
The trial excluded patients who required medications affecting blood pressure or cardiac rate at or after enrollment. A patient needing those agents may not match the population in which guanfacine extended-release was evaluated.
Clinical Considerations
- This trial enrolled only Japanese adults, so generalizability to non-Japanese populations is uncertain.
- The study excluded many common psychiatric and cardiovascular comorbidities, limiting applicability to more complex adult ADHD presentations.
- The treatment period was short, so this guide reflects short-term selection for a 10-week efficacy and safety study rather than long-term practice.
- The groups had some age imbalance and a relatively large proportion of men.
Bottom Line
Apply this guanfacine extended-release evidence mainly to adults with DSM-5 ADHD who have clinically significant symptoms but do not have the psychiatric, substance-related, seizure, suicide-risk, or cardiovascular exclusions used in the trial.
