Evaluation of Guanfacine Prescribing Practices for Attention Deficit Hyperactive Disorder Management: A Retrospective Medical Records Within a Child Development Service

AIM: Guanfacine is a second line option for management of Attention Deficit Hyperactive Disorder (ADHD) and can be prescribed adjunctively with stimulants or as monotherapy. This medical record review evaluated prescribing practices, vital sign changes over time, and client outcomes. METHODS: This retrospective medical record review examined 171 records of clients on guanfacine modified release within the Child Development Service (CDS) in Perth, WA, between February 22, 2022, and May 5, 2022. Clients on guanfacine for one week or less were excluded; those who had ceased guanfacine at the time of review were included. RESULTS: Clinicians completed serial vital sign measurements during guanfacine titration for 92 clients (54.12%), partially completed them for 58 clients (34.12%), and did not complete them for 20 clients (11.76%). No significant changes in systolic/diastolic blood pressures or heart rate were observed following guanfacine prescription. Clients on adjunctive therapy reported fewer side effects than those on monotherapy, 26.7% vs. 50.0%, χ2 (1, N = 166) = 9.59, p = 0.02. This relationship was strongest in clients with an Autism diagnosis, 20.0% vs. 51.6%, χ2 (1, N = 61) = 6.61, p = 0.01. A similar but not significant trend was observed in children with ADHD alone, 25.8% vs. 63.6%, χ2 (1, N = 60) = 3.26, p = 0.071. CONCLUSIONS: Clients prescribed guanfacine adjunctively with stimulants reported fewer side effects compared to monotherapy, supporting early adjunctive use in suitable cases. Blood pressure and heart rate remained stable across the cohort. Serial vital sign measurement was performed in 50% of cases.