Any experience with guanfacine (Tenex/ Intuniv)?

[Febrifuge]

Just wondering about any experience anyone might have had. More out of simple curiosity than anything.

 

I've been following a patient, mid-40s male, bad genetics for HTN, not great on lifestyle either. Nonsmoker, but no structured exercise, diet a mix of healthy and very much not. This person was on 10mg lisinopril for over a year, which worked nicely to get 120s/ 80s (previous to meds, he gradually crept up to consistent 140s/90s for long enough he was "sentenced" to meds).

 

The lisinopril caused a dry cough even at that low dose, so triamterene/ HCTZ was next. The first week on that, he had a few 150s/100s, plus reported headaches, vague somatic symptoms ("not pain, not tingling, just a weird feeling" in the volar forearms, not light-headedness or vertigo, just "a weird feeling" in the head). After about a month, BP is okay, 130s or 120s/ 90s but with as many high 90s as mid-80s.

 

This person also has ADHD, and did some reading online. It's been pointed out that guanfacine is used for both HTN and ADHD, and the patient (rightly, I think) points out that 10mg of methylphenidate, while helpful for their symptoms, is probably not helping the HTN issue.

 

Would it be crazy to add guanfacine to the Maxzide and maybe kill two birds with one stone? They would stay on the methylphenidate.

 

I can find recent stuff about the drug for ADHD, but that's in teens. For HTN, I can't find anything that isn't from the 1980s. Does anyone use it anymore?

[ventana]

I would do an ARB before anything else, then likely norvasc

 

I tend to not place much weight in the ADD and ADHD dx these days, just about anyone "could" be that with the right

[Febrifuge]

Thanks. I'll have to see what the PCP does. I had wondered why the diuretic before an ARB, but I'm not the primary care dude so I didn't stick my nose in too much. The question of guanfacine is interesting to me, since it's one of those meds I basically never see "in the wild."

[Joelseff]

ARB, then can add HCTZ or Chlorthalidone (actually you can try this alone). Why maxzide after Ace? if ACEi controlled his HTN alone, I would've stuck with an ARB.

 

edit: sorry stupid auto complete on my stupid phone :wacko:

[Febrifuge]

Why maxzide after Ace? if ACEi controlled his HTN alone, I would've stuck with an ARB.

 

It's a good question! Maybe the patient will ask.

[Joelseff]

It's a good question! Maybe the patient will ask.

sorry I didn't read your post above mine before I posted :o

 

[gamecaco4]

I personally know of a child who had HTN and ended up on guanfacine after being taken off lisinopril. His HTN was near the point of normal for height/weight, but still slightly high for age. His nephrologist (hx of benign hypertensive renal disease after being born with hydronephrosis), psych, and ped all agreed that guanfacine would be a great choice for him and it was. His HTN leveled off and his ADHD symptoms were eased.

[treejay]

I have seen Tenex used strictly for ADD/ADHD while I was a student.  Perhaps it was because the clinician wanted to avoid the amphetamines.  And I think it's cheap and covered by most insurance