ABSTRACT
CLONIDINE AND GUANFACINE Clonidine and guanfacine, α2-adrenergic agents with known antihypertensive efficacy, have no established FDA indications for use in child and adolescent psychiatry. Because they activate presynaptic α2 receptors, which through their negative feedback action cause postsynaptic inhibition of central noradrenergic neurons, clonidine and guanfacine may be particularly useful agents in psychiatry. They are currently under active investigation to better discern their role in the treatment of children and adolescents. Thus far, they have been most studied with regard to Tourette’s disorder, attention-deficit hyperactivity disorder (ADHD) in children and adolescents, and the control of opiate withdrawal symptoms (primarily clonidine). Indeed, clonidine has been recognized as an effective antihypertensive agent in adults since the 1960s (Wilber, 1980), while Leckman and Cohen (1983) and Hunt et al. (1985) extended its use to pediatric ADHD patients with and without Tourette’s disorder for whom stimulants were contraindicated, ineffective, and/or associated with problematic side effects. Swanson et al. (1995) reported that by the early 1990s, about 200,000 prescriptions were
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being written for clonidine (0.05-0.1 mg in multiple doses throughout the day) for pediatric patients with ADHD (Hunt et al., 1990) and patients with sleep disturbances (stimulant-related and unrelated) (Rubinstein et al., 1994; Wilens et al., 1994).
