Tenex (Guanfacine) is usually taken once or twice daily.  It can be taken 3-4 times/day but it has a 16 hour half life so frequent dosing is not necessary.  If taken regularly total blood levels will gradually increase over the first three days and then will level off.

Tenex comes in 1 and 2 mg tablets that are easily broken in half.  If taken primarily for help with sleep or if an individual is very sensitive to side effects it can be taken in the evening.  For irritability, muscle spasms, anxiety, increased blood pressure or any symptoms associated with high levels of norepinephrine it is usually taken in the am or am and evening.

As with most medications, start with a low dose – ½ of 1mg and gradually increase as needed until the right dose is found.  Extra doses can be taken for acute symptoms like agitation associated with increased or unusual stress.

Side-effects are usually mild and transient – especially sluggishness or dizziness.  If any side effects are bothersome decrease the dose and take at bedtime only.

Tenex (generic Guanfacine) is a medication that has been used for years as a mild antihypertensive.  In the body and in the lower brain centers it reduces the release of norepinephrine (sometimes called noradrenalin).  In the prefrontal cortex in the front of the brain it decreases sensitivity to distracting stimuli and therefore helps with focus (on target stimulus).  A slow release form of Tenex will likely be FDA approved for ADHD within the next year or two. There are good controlled studies showing that Tenex benefits many ADHD symptoms although it doesn’t help with boredom or enhance ability to focus on things the ADHD individual has low interest in.  Only stimulants help the full range of ADHD symptoms and that’s why stimulants are considered the first line treatment.

 
Stimulants increase norepinephrine throughout the brain and sometimes in the body.  In the prefrontal cortex this helps decrease distractibility but in other areas of the brain it sometimes causes nervousness, insomnia, decreased appetite, or irritability and in the body can cause muscle twitches, stomach ache, or increased blood pressure.  In the lower brain centers in children it has sometimes been found to delay growth.

 
All of these negative effects can be reduced or eliminated by Tenex (Guanfacine) plus distractibility is further improved.  If taken in too high a dose it can cause sluggishness or dizziness and occasionally can cause swelling.  It is one of my top 10 most frequently prescribed medications – usually with stimulants or sometimes antidepressants.  It can be taken once or twice daily (See how to take) because it has a half life of 16 hours – it can be effective if taken just once a day.

 
Tenex is related to Clonidine.  But Tenex is 10 times stronger in the prefrontal cortex than in lower brain centers where Clonidine has the same potency in all brain areas and is therefore much more sedating – sometimes causing morning drowsiness when taken at night.  But some people need the higher sedation at night and it has a stronger enhancement of growth hormone – in fact Clonidine is sometimes abused by body builders to increase muscle building.

 
Many of my patients have found Tenex to be helpful for social anxiety.  It reduces symptoms like sweating, and dry mouth but it also decreases distractibility.  People with social anxiety are distracted by negative or “what if” thoughts.  They are also distracted by physical symptoms and they are distracted by any negative cues in their environment, e.g., if giving a presentation and one person yawns the immediate thought is, “I must be boring”.  It’s very hard to do a good presentation when your mind is jumping all over the place.  Stimulants also help social anxiety by increasing control of what you focus on.  The combination of stimulants (such as Adderall XR, Daytrana) and Tenex is especially helpful in lowering public speaking anxiety symptoms so that with adequate opportunities to practice, public anxiety response will gradually desensitize.

Question: What are the best medications for ADHD?

Answer: Surgeons are practical. “A difference that makes no difference is no difference”. Recognizing ADHD and finding the right treatment makes a dramatic difference in someone’s life.  ADHD is relatively easy to diagnose. There are more studies showing the effectiveness and safety of medication in treated ADHD than in any other mental health disorder and most general medical disorders.

Stimulants are almost twice as effective as other types of medication (like Strattera, Provigil, and Wellbutrin XL, Tenex). Long acting stimulants are usually safer (especially less rebound) and more effective. Sometimes short acting medications can be used to supplement the long acting stimulants. Some people do better on amphetamines and some do better on methylphenidate type of stimulants. Some do okay on either.

More people do better on amphetamines according to one study.  In another study amphetamines were more likely than methylphenidate to allow ADHD patients to function at the highest level.

In general, amphetamines are more effective for the majority of ADHD patients because they have a broader spectrum of action relative to both subtypes of ADHD symptoms.  Because amphetamines have been shown to be very effective for a higher percentage of patients than methylphenidate, I start most patients on Adderall. Because long acting medications are safer and generally more effective I start with the XR form. It generally has at least an 8 hour duration of good effect. Some people take it twice a day to get 16 hours of calm focus.

I use the new Daytrana patch if Adderall does not work well, or when the advantage of the patch lasting up to 15 hours is the most important clinical consideration.

Some patients prefer Adderall because of the help with weight control - not usually decreased appetite but they stop eating out of boredom or stress. They also are more physically active and more likely to be able to motivate themselves to exercise. In fact, stimulants in general enable an ADHD person to choose what they want to do or focus on instead of being at the mercy of only doing things they have a high interest in.

To me, the ultimate test of medication is how it does in the long term.  I tell patients I’m not interested in them coming back and saying, “I think it’s helping a little bit doctor”.  I’m looking for, “This medication is great. It has helped me change my life and I don’t have any significant side effects”, and they are still saying it 1 year, 5 years, etc. We have almost 70 years of research showing the effectiveness and safety of amphetamines and 55 years with methylphenidate. I have patients who have done well on stimulants for over 30 years. I don’t see any long term problems. I can’t say that for any other type of medication that I prescribe.

I frequently add Tenex (Guanfacine) to stimulants to enhance efficacy and to further minimize side-effects.

Click link below for new ADHD med info:

www.askdrjones.com/2007/07/16/vyvanse-new-treatment-for-adhd/