Guanfacine Bupropion

The proposed mechanism of ADHD pharmacotherapy is to modulate neurotransmitters in order to improve academic and social functioning. Pharmacologic therapy can be divided into two categories stimulants and non-stimulants. Stimulant medications include methylphenidate, dexmethylphenidate, amphetamine salts, and dextroamphetamine, whereas non-stimulant medications include atomoxetine, tricyclic antidepressants (e.g., imipramine), clonidine, guanfacine, and bupropion. 

Stimulants are first-line treatment for ADHD atomoxetine, bupropion, and tricyclic antidepressants (TCAs) are second-line agents clonidine, guanfacine, and other medications are adjunctive treatments. 

At this time, the preferred first-line drug therapy for ADHD is either methylphenidate, dexmethylphenidate, mixed amphetamine salts, or dextroamphetamine. Atomoxetine, bupropion, or TCAs are good options for those umesponsive to or unable to tolerate stimulants. Clonidine and guanfacine are third-line options or adjuncts that require careful cardiovascular monitoring. Mood stabilizers (e.g., lithium, divalproex, and carbamazepine) and atypical antipsychotics are adjuncts for control of aggression or comorbid bipolar disorder. Other agents require further investigation before their status in the treatment of ADHD can be fuUy determined. 

A grand mal seizure in a child, which was attributed to an interaction between bupropion and guanfacine, was later identified as being more probably due to a bupropion overdose. 

TiltonP. Seizure associated with bupropion and guanfacine. 

Tilton P. Seizure after guanfacine plus bupropion correction JAm Acad Child Adolesc Psychiatry (2000) 39, 1341. 

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