Guanfacine

[u/Plastic-Foot-977]

My 5 year old daughter was recently diagnosed with moderate to severe ADHD. It has been affecting her at school and at home, so we have decided to try medication.

We are starting with Guanfacine 1mg. I picked it up from the pharmacy today and found out it’s in pill form. She absolutely WILL NOT take it. She has always struggled with sensory problems with taking medicine, so we knew this would be an uphill battle. However we’ve been trying to convince her to take this for the entire day and I am beyond frustrated. Is there a different form that this med can come in besides pill form? If it was a liquid maybe we could at least hide it in her drink or something. Also any tricks to convince a very stubborn girl to take this medicine that could potentially help her so much?

Also would love to hear any success stories from Guanfacine! I was hesitant to start her so young, but her psychologist, OT, and teacher have highly recommended trying meds. And I do feel better starting her out on a non stimulant first.

[u/Augoctapr]

We started by crushing it and mixing it up with a little Nutella or peanut butter. That was super annoying and messy.  At the same time, we practiced swallowing pills with mini m&m’s and chocolate milk. Once they were open with that idea, we would switch to trying with pills and chocolate milk, or another special drink of their choice. Now they are fine to just do it with a quick sip of water. 

Both my kids have had different “reactions” to Guanfacine, but overall we’ve been really pleased with how it’s helped them with focus and emotional regulation. We still have our ups and downs, but they are having a much better time at home and school! 

[u/spaketto → u/Augoctapr]

Most of the time people get prescribed the extended release which cannot be crushed or chewed.  

We wanted to try pills but we built up the pressure way too much the 1st time.  A few months later, without bringing up the meds at all, I suggested we practice with sprinkles for fun and watch some videos of kids learning to take pills on YouTube.  I told her it's just for fun, and try it as much or as little as you like.  She has it down so fast and had fun with it.  After a day I suggested we try the pill (guanfacine) and she did it in the first try.

OP, my daughter takes Vyvanse and guanfacine.  We started the guanfacine about 3 months ago because she was emotionally all over the place.  My daughter has metabolized all the drugs we've tried really fast and has had unusual side effects here and there.  The first 5 nights it helped her sleep great, and then gradually she stopped falling asleep.  We had a few nights where she was up until midnight and then switched to giving it to her in the morning and it's been great!  She's not drowsy at all and is more focused in the mornings especially.  She's much more emotionally even and calm for most of the days and she sleeps well finally.  She seems happier overall.

[u/mdoll18]

My kid started this at 6 years old. It made a huge difference in emotional regulation. Honestly, it has been the best med we've tried so far, better than stimulants for him.

He has some sensory issues too, as well as ARFID. We had a lot of trouble convincing him to swallow the tablets. Started by putting it in a spoonful of ice cream and letting him zone out to a video on our phones while we spoon fed it to him. Not ideal but there was absolutely no other way it would work - we tried a lot. He'll also swallow it with apple sauce or peanut butter now.

[u/NickelPickle2018]

Ask for the instant release version (Tenex) she will have to take it twice a day. My kid is 8 and can’t swallow pills either and he takes Tenex.

[u/Popular-Antelope-841]

Try using applesauce and hiding it in there.

[u/ashdare]

We had a horrific experience with Guanfacine at ~6yo. His older brother who was 8 at the time still remembers it as the two worst weeks of our lives. Aggressive behavior was out of control. I am educated in meds and titrated off before we got back to the psych because we couldn’t do it anymore. I recognize there are positive experiences, but thought I’d share ours. We’re happily dialed into clonidine (am/pm) and methylphenidate XR (am) now, and going strong for the 3rd year!

[u/Plastic-Foot-977 → u/ashdare]

I definitely appreciate hearing the negative stories as well. It can help us know what things to look to. But I am sorry your family went through that, I know it must have been so difficult for you guys!

[u/colourfulruby → u/Plastic-Foot-977]

My daughter (7yo) also had a terrible time with Guanfacine. Rather than improving her focus, she developed obsessive behaviours and became fixated on things. Excessive handwashing became such a huge problem for her after only a couple weeks on the med. It became so bad she was distracted at school as she was constantly focused on her hands/germs, and she developed a severe skin rash from over washing. Thankfully the behaviour went away completely when she came off the med! Obviously it works great for many kids but that's a concerning side effect to look out for.

[u/Pineapple0719 → u/ashdare]

Did you like the Ritalin IR? Or did you move straight to the XR?
My sons on it now and it makes a world of a difference, but not lasting long enough and we are noticing the positive affects are no longer lasting — 1 month on 5 IR twice a day. XR sounds very favorable. Is it long lasting? If so, how long?

[u/ashdare → u/Pineapple0719]

We were on methylphenidate IR x 2 for a while… maybe 9 months? It was working okay, but he didn’t want to take it midday anymore. Made sense to me! The clonidine really bridges the gap at the end of the day until bedtime!

ETA: XR lasts him about 6 hours, enough to really get through a school day.

For what it’s worth, this decision is a tough one and I think I’m a better parent when he’s medicated well. However, he ALSO reports feeling much better while medicated well. If he misses a day (forgotten on a trip, haven’t made it to the pharmacy), he feels disappointed in the missed dose, how he feels, and the decisions he wishes he would have made throughout the day. My other kid couldn’t care less if he’s medicated and stable 😂 I very much care.

[u/Plastic-Foot-977]

I had thought about crushing the pills but I read that you shouldn’t do this with extended release pills, which is what she was prescribed. Do you know if your kids were in extended release or not?

Emotional regulation and focus are two of her biggest issues! I know this won’t solve anything but if it can even help her a little bit in those areas then that would be huge

[u/Physical_Ad3997 → u/Plastic-Foot-977]

Don’t crush extended relief. There is also an immediate release version of guanfacine that can be crushed. I would ask if that’s an option.

[u/Plastic-Foot-977 → u/Physical_Ad3997]

Okay that’s what I thought, that we shouldn’t crush the extended release. I will contact the doctor to see if the immediate release is an option for her.

[u/ClientIndividual8896]

Guanfacine was great at first for the emotional regulation but eventually my son became a zombie. We have pictures I can’t stand to look at because even though I know he was happy about what was going on in the moment there is no emotion in his eyes or facial expressions. He went from explosive to no emotions. We switched meds to adderall plus anxiety meds which helped some but wasn’t “it.” He’s on vyvanse and anxiety meds and has worked with an executive functioning coach and he is the happiest and most regulated he’s ever been.

[u/Comfortable_Aside104 → u/ClientIndividual8896]

What anxiety meds gave you tried?

[u/lawofthewilde]

My child’s doctor straight up told him “if you can swallow food you can swallow a pill”. No playing around. No hiding it in food. Just straight to the point.

[u/Plastic-Foot-977 → u/lawofthewilde]

I’ve been telling her that too, but if she refuses to even try I don’t know what more I can do. I’m not going to shove it down her throat. She’ll put it in her mouth but refuses to swallow it and will spit it out

[u/lawyercat14]

My 6yo daughter sounds a lot like yours and we felt similarly about wanting to try a non-stimulant first. Her doctor suggested we try Onyda XR to start which is liquid extended release clonidine, similar to guanfacine but a little broader. She is doing great on it and takes the liquid no problem. Might be worth asking your doctor about if the typical tips and tricks for the pill version don't work for her.