ebook_ADHD2019

The World Federation of ADHD Guide 99 depending on response. For children, our practice is to initiate treatment at the recommended dose of 1mg for one week and then increase to 2mg for another week. Whilst there are a very small number of patients who do respond to these very low doses, the main purpose of this phase is to assess potential adverse ef- fects (especially somnolence, bradycardia and hypotension). We then increase the dose to 3mg and reassess for clinical response after another six weeks. If there is no response at this dose, it is unlikely that response will occur at a higher dose. Where there has been a partial response at 3mg, we will increase doses to 4mg (and further for adolescents). Clinical trials identified a dose- and exposure-rela- ted response for both clinical improvement and several adverse events (hypoten- sion, bradycardia, sedation). To provide a balance between benefits and risks, it is recommended that the target dose range is between 0.05 and 0.12 mg/kg/day with a total daily dose between 1-7 mg (See Table 5.2). Following discontinuation of guanfacine it is possible for patients to experience increases in blood pressure and heart rate. It is therefore important to instruct patients and their caregivers not to discontinue their medication without consulting their doctor. Pulse and blood pressure should be monitored when reducing the dose or discontinuing this me- dication. Good practice is to taper the dose down in decrements of no more than 1 mg every 3 to 7 days to avoid possible rebound hypertension. For those living in hot countries, it is also very important to pay close attention to hydration status as dehydration may result in more extreme degrees of hypotension and bradycardia. Table 5.2 RECOMMENDED TARGET DOSE RANGE FOR THERAPY WITH EXTENDED RELEASE GUANFACINE Weight Target dose range (0.05 – 0.12 mg/kg/day) 25-33.9 kg 2-3 mg/day 34-41.4 kg 2-4 mg/day 41.5-49.4 kg 3-5 mg/day 49.5-58.4 kg 3-6 mg/day 58.5-91 kg 4-7 mg/day >91 kg 5-7 mg/day Doses above 4 mg/day have not been evaluated in children (ages 6-12 years) Doses above 7 mg/day have not been evaluated in adolescents (ages 13-17 years)