Titrating guanfacine in the inpatient

[Madden007]

Had a child who was on 4mg on guanfacine in the community. He missed about 2-4 days of medication, and was recently hospitalized. I did not start him back at 4mg, but decided to begin the titration schedule again. Would some of you have started him back at 4mg? Also, given that the recommendation titration schedule is about 1mg/week, can I titrate him up more aggressively in the inpatient, e.g. 1mg/2-3 days, given he has already tolerated 4mg? thanks

---

Members don't see this ad.

 

[Merovinge]

Keep in mind that Tenex has a longer half life than therapeutic effect (never heard the explanation for this, but it is what it is). I would be pretty comfortable resuming 2mg immediately and then adding a mg every 2-3 days if you are inpatient and getting routine vitals. I am all for conservative titrations on the outpatient side but inpatient completely changes the game with frequent vitals, 24/7 nursing.

Outpatient actual adherence is a complete joke compared to what physicians expect it to be, people are coming on/off our meds even at high dosages all the time without you knowing. Having seen a TEN case from Lamictal as a med student has kept my prescribing of this drug to a minimum as I cannot count the number of times I've seen people ping-pong from 0 to 200mg a day.

 

[whopper]

Why ask us? The titration guidelines per the FDA aren't a secret. They're out there in various sources.

[0.5-2 mg PO qhs]Start: 1 mg PO qhs, may incr. to 2 mg PO qhs after 3-4wk; Max: 3 mg/day; Info: taper dose over 4-7 days to D/C

 

[Madden007]

Why ask us? The titration guidelines per the FDA aren't a secret. They're out there in various sources.

[0.5-2 mg PO qhs]Start: 1 mg PO qhs, may incr. to 2 mg PO qhs after 3-4wk; Max: 3 mg/day; Info: taper dose over 4-7 days to D/C

I don't think you understood my question. Thanks for the feedback, anyways.

 

[Madden007]

Keep in mind that Tenex has a longer half life than therapeutic effect (never heard the explanation for this, but it is what it is). I would be pretty comfortable resuming 2mg immediately and then adding a mg every 2-3 days if you are inpatient and getting routine vitals. I am all for conservative titrations on the outpatient side but inpatient completely changes the game with frequent vitals, 24/7 nursing.

Outpatient actual adherence is a complete joke compared to what physicians expect it to be, people are coming on/off our meds even at high dosages all the time without you knowing. Having seen a TEN case from Lamictal as a med student has kept my prescribing of this drug to a minimum as I cannot count the number of times I've seen people ping-pong from 0 to 200mg a day.

Thanks. That was helpful.

 

[calvnandhobbs68]

Why ask us? The titration guidelines per the FDA aren't a secret. They're out there in various sources.

[0.5-2 mg PO qhs]Start: 1 mg PO qhs, may incr. to 2 mg PO qhs after 3-4wk; Max: 3 mg/day; Info: taper dose over 4-7 days to D/C

That's for an initial titration...not restarting someone on a dose they previously tolerated. I'd agree with the rapid re-titration as above. You're most concerned about the BP side effects and if you're checking their BP every day you can increase pretty quickly. We increase every 1-2 days on the inpatient child psych unit all the time if needed.