The Difference between Clonidine and Guanfacine | ADHD Management - Alpha-2 Agonists as Key Players
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- Опубликовано: 7 июл 2024
- In this informative video, we delve into the world of Alpha-2 Agonists and explore their crucial role in ADHD management. Specifically, we will compare two popular medications - Clonidine (Catapres) and Guanfacine (Intuniv) - to help you discover their key differences.
Key moments:
00:00 - Introduction to the Differences between Clonidine and Guanfacine (Intuniv)
1:17 - Mechanism of Action of Clonidine
3:25 - Benefits of Clonidine
4:28 - Mechanism of Action of Guanfacine
5:50 - Clinical Application of Clonidine and Guanfacine
Alpha-2 receptors play a pivotal role in our neural circuitry, influencing everything from attention regulation to stress response. We break down the science behind these receptors, dissecting the presynaptic and postsynaptic functions that shape our brain's activity.
Learn how Clonidine, with its unique alpha-2A, alpha-2B, and alpha-2C agonistic activity, takes centre stage in treating ADHD, insomnia, PTSD, and even pain management.
Discover how this agent strategically targets specific areas, optimizing noradrenaline levels and bringing relief to hyperactivity and sleep disturbances.
Meanwhile, Guanfacine steps in as a selective alpha-2A agonist, perfectly tailored for ADHD treatment. Uncover its specialized role in strengthening neural networks and countering hyperarousal symptoms. Plus, we'll unravel the mystery of its minimal hypotensive effects and why it's a go-to option for certain cases.
Understanding these mechanisms is essential in comprehending how these Alpha-2 Agonists effectively manage ADHD symptoms.
But that's not all! We will also address a common concern - sleep disturbances. Many individuals with ADHD struggle with sleep issues, and we will discuss how these medications can impact sleep patterns.
For more informative videos and tips on various aspects of mental health and well-being, don't forget to subscribe to our channel and hit the notification bell to stay updated. Remember, your journey to better ADHD management starts here!
Please remember that this video does not replace professional medical advice. Always consult with a healthcare professional for accurate information.
#ADHDManagement #Alpha2Agonists #ClonidineVsGuanfacine #ADHDTreatment #MentalHealthTips #MedicationComparison #InformedDecisions #ADHDSymptoms #SleepDisturbances #WellBeing
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this was a great video - getting straight to the elusive mechanics and soundly explaining the profile of these drugs/ wish there were more like these
Thanks.🙏🏼
Amazing Series
As a Psych NP who used to work in the ICU I rarely prescribe clonidine because I still remember clients (usually intubated) who were exhibiting severe hypertension refractory sometimes to even things like a nitroprusside drip. When the ICU doctors would learn (from a better family med history or the client) that they also took 0.2 mg clonidine twice daily and this was added back the BP would often go from something like 180/100 back to 120/80. Thus, my fear is setting clients up (especially kids) for long term hypertension issues. On the other hand your video points out unique benefits from clonidine relative to guanfacine that some of my clients who have PTSD, ASD, and chronic pain might benefit from relative to guanfacine (IR or ER) which I use more frequently. I would like to see someone expand on Oren Mason's work on "combined therapy for ADHD" as I often treat this condition and there is either incomplete response to stimulants, or intolerance. Sincere thanks,
To manage ADHD - the fronto striatolimbic system has to be addressed as a whole. Stimulants address the frontostriatal part but not the limbic ( can even worsen it) - the limbic part heavily mediated by amygdala requires agents that reduce arousal or activation - this is where clonidine features. It’s linked to the basics of neuroscience of ADHD.
this response did not address her concerns about setting kids up for lifelong high blood pressure issues at all. @@PsychiatrySimplified
I am on Clonidine and a bit worried after reading this comment about high blood pressure if the drug is stopped. I hate the idea that my body may become dependent on this to keep blood tension regulated
@@clairem3707 If you're going to stop taking it, make sure to taper off and not stop suddenly. Rebound hypertension is more likely when people stop suddenly (unless you had hypertension to begin with). How you schedule your tapering is something you need to discuss with your doctor. If you're worried about running out, keep some spare doses and work out a plan (with your doctor) for how to take them if you don't think you will be able to get more before you run out.
Thank you so much sir ❤
This series of videos is great for grasping the complex concepts of psychopharmacology.
Hopefully you will cover all of them 😍
Hope so too (:
very nice information, thanks
Glad it was helpful!
Really interesting way of explaining 👍👍👍
Thanks 🙏🏼
Very informative video👍
Glad you think so! Thanks🙏🏼
excellent
Thanks for the feedback. 🙏🏻
Thanks!
Appreciate it 🙏🏻
Please do make a video on Phenelzine, there’s criminally little content online for such a highly rated drug!
Will keep in mind. We've covered MAOIs a bit on the Antidepressant video.
Guanfacine and clonidine are both medications that can treat ADHD and high blood pressure, but they have some differences in their potency, effects, and side effect
Thanks for the informative video sir👍🏻. It was really helpful. I'm in my 30, i was diagnosed with ADHD 6 months back. I'm alo suffering from obesity, eating disorder & Alopecia. My Psychiatrist prescribed me Bupropion - 300 mg, Armodafinil - 150 mg. My Dermatologist prescribed me oral Minoxidil - 5mg and Finasteride - 1 mg, CoEnzymes Q10- 100 mg & Multivitamin tablets - 1 mg for treating male pattern baldness. Can I ask my Psychiatrist to include Clonidine or Guanfacine. Is it ok to take all these drugs at same time in morning. Need your kind suggestion on this sir. Thanks in advance 😊
Depends on what you are trying to target? Which specific symptoms. As you can see in the video they are meant for specific targets. Both usually prescribed at night as they help with sleep ( clonidine especially) .Best to discuss this with your doctor as they know your details better
Plz do videos on psychopathology fish and sims
That is a great idea. I'll keep it in mind and try to do it in an interesting way.
Most of us unable get best explanation for psychopathology books data ,each person has different ability to imagine particular statement in different way , those books are with out proper examples which are not suitable for locality
I know what you mean. I tried to connect some of the phenomenology in the cases I did - The Burari Deaths and The Elisa Lam case on this channel . Have a look - feedback would be appreciated.
very good. YEt what about reported treatment options for ASD? My daughter is low level functioning autistic, with imo ADHD-like behavior and sleeping problems. What about weight gain as a side effect? By the way, in the 90s I think it was the ritalin hausse started. Some old school pychiatrists would stress the virtue of clonidine (also treatment of tics/Gilles de la Tourette) yet it was a lost cause...
Weight gain is not an issue with these two agents. Melatonin deficiency can be present in significant proportion of individuals with ASD - here is an article which covers range of options. Also for sleep disturbances important to rule out tonsils, adenoids sleep breathing disorders, iron deficiency anaemia, RLS etc
starting guanfacine soon, taking ritalin currently but giving me high anxiety looking to see if it helps when combined with a stim
If Guanfacine doesn’t - clonidine is usually better as Guanfacine is post synaptic - clonidine pre synaptic and reduces arousal . Not advice
Thanks! @@PsychiatrySimplified
My apologies as this is totally (or somewhat unrelated to the video) but do SSRIs increase GABA concentrations in the prefrontal cortex? I’m reading the medical literature and I’m only finding evidence of increases in occipital GABA levels subsequent to SSRIs being administered in studies. Maybe I haven’t found my right study yet. Any response is greatly appreciated, Dr. Sanil. Barry, from Canada.
Not in the prefrontal cortex. Not specifically as an action - no. Certain 5HT receptors are present on GABA interneurons that inhibit GABA which indirectly increases DA in the PFC BUT not GABA. We have covered this in the vortioxetine video.
Do NOT take ssri's if you have ADHD. It raises serotonin intake and lowers dopamine intake in the brain, which is awful for those who have ADHD, since dopamine intake is already low and unbalanced. I can speak from personal experience, as Lexapro almost ruined my life.
@@user-rf1op3uh6nI don't believe that's an absolute rule. Especially when combined with the right stimulant, the right SSRI can be _great_ . Although it's not exactly my personal experience as well, but SSRIs don't work well for me in any case. I take an MAOI. (And methylphenidate)
Hello, my mum was wondering if you have a video on pregabalin?
No we don't. Perhaps one to do. Sorry
@PsychiatrySimplified would love to see an overview of the gabapentinoids! Very difficult to understand how VGCC'S affect brain structures and neurotransmitter release.
Thanks for your Video. I am using guanfacin against my PostVac issues and it helps a lot. Unfortunately it is not deliverable at the moment in Germany. Are there another alpha2 agonists available, which enhance blood flow in the brain, reduce symphathetic activity, and reduce heart rate? This would mean a lot to me! Thank you
Clonidine. Prazosin can be used but it’s alpha 1 antagonist ( also reduces sympathetic activity) but has shorter duration of action
@@PsychiatrySimplified Thank you! I also have alpha1 GPCR auto-antibodies. Maybe it shows some dual effects, by blocking the receptor. A dysregulated nervous system plays a big role in PostVac and PostCovid. Deep meditation helps, but without a "stabilizer" it is getting tough.
Which do you think would be preferred for long covid woth dysautonomia? I see a lot of doctors trialing these drugs.
I've covered it in detail here - as the answer would be depends on symptoms being targeted - ruclips.net/video/dIspvIMws2U/видео.htmlsi=xEEycXKK6KEE-kz7
Could you take both (at lower doses) simultaneously in order to get the benefits of lowered arousal from Clonidine and improved cognition from Guanfacine?
In general it can be done under medical supervision. BP would need to be monitored. Ps not advice
I might have gotten the wrong message at 1:51, but when you explained clonidine exerts its effects predominantly at the pre-synaptic alpha receptors, it reduces NA levels. Then you followed up by saying it “optimises the level of NA in the pre-frontal cortex area”.
How is a reduction = optimisation? Please may you explain to me thank you 🙏🏽
Excess NA in PFC stimulates the alpha 1 receptors which impairs cognition. Alpha2A is needed for adequate cognitive functioning. A goldilocks effect. Clonidine helps in achieving homeostasis in the PFC & Amygdala ( as excess amygdala activation is usually responsible for elevated NA in PFC ) .
But when we are dealing with ADHD, normally dopamine and NA are in “short supply” and hence mph and dex are helpful as they boost these 2 neurotransmitters in our PFC, thus improving executive functions.
So how come when clonidine reduces NA, it also improves executive functions? 🤔
@@kpwchan16 No, they aren't always in short supply. Cognitive issues are also due to excess NA (emotional arousal model), activating alpa 1 . hence why some don't tolerate stimulants. Clondine reduces this excess and he's the NA to act on alpha 2 A which is adaptive. Moroever it also has some alpha 2 post synaptic receptors which enhances cognition.
I see, thank you very much for the detailed explanations!
Could ADRA2A C/C gene indicate Guanfacine as a potential effective treatment for ADHD since baseline alpha2A receptor activity is reduced in that genotype? I know that the C/C polymorphism predicts poor response to methylphenidate. My childhood experience with ADHD treatment confirms this, retrospectively. It seems that the alpha2A postsynaptic receptor could present a bottleneck for the whole network explaining the lack of efficacy of methylphenidate treatment in that genetic polymorphism. Curious to hear your thoughts.
It’s possible but in clinical practice the best guide is patient symptomatology supplemented by investigations. Genetic tests or other tests cannot necessarily predict response.
@@PsychiatrySimplified Thank you for taking the time to reply! I see genetics as one of several factors that could be weighed when evaluating treatment options. I'm working with my provider to try guanfacine XR.
Could you please let me know the difference between a regular psychiatrist in a neuropsychiatrist? It seems here in the United States that they are the same thing and I’m having trouble finding anyone to help me with CFS and pots because I’m not tolerating any of the medicine. Thank you so much
I understand your point - guess best way of putting it is to identify psychiatrists that work within a multidisciplinary team with other specialists that take a broader framework in treatment.
@@PsychiatrySimplified Thank you so much I posted a couple questions under your last chronic fatigue post as well. Would you mind getting back to me on that? I’m in severe severe severe suffering and really need help. Your direction could help save my life thank you
Hello! I am actually trying to better understand Guanfacine. Here it seems you focused more on clonidine. I am trying to find out if Guanfacine causes emotional blunting or sexual side effects! Do you know this type of information?! I'd love help!
There is no significant association with sexual side effects or emotional bunting as with SSRIs. It is likely to improve cogntition and emotion. The mechanism of action of guanfacine is not linked to these SEs. However every person is different and individual characteristics may need to be taken into account before prescribing. But these side effects are rare. Ps not advice
What is the Diffrence between Propranolol and Clonidine?? Would Propranolol also calm down, reduce Anxiety and Panic symptoms, but You would still have symptoms of ADHD?? And is it possible to take toogether Propranolol or Atenolol for hard heart Beat, and Clonidine for ADHD in Adullt, if there is Blood preassure high, Genetic like about 137/88
Propranolol is a beta blocker. Can reduce anxiety and panic . Clonidine reduces hyperarousal ( see the video on the difference between anxiety and hyperarousal to understand the difference ) . Clonidine helps with sleep : propranolol reduces melatonin and hence can affect sleep. In general if indicated an d with optimal dose adjustment and optimisation to modulate BP it is possible to prescribe the combination. But this will need specialist input. Generally all 3 are not needed as based on symptoms one or two may be needed. Clonidine reduces BP and heart rate. Ps not advice
@@PsychiatrySimplified Thank You 🙏👍
Can you use both of them to create synergy. Clonidine to work pre-synapses and Guanfacine to work post-synapses. I try to find some studies about this mix but I find nothing
Good question. Yes can be done by a clinician with experience. Safe as well when done appropriately. The doses of both will be low in such a circumstance. Ps not advice
@@PsychiatrySimplified Thank you !
I'm my psychiatrist's only patient on clonidine. He prescribed it to me because after I did some reading about it I told him that it might be worth a try. But of course I'm not an expert and the constellation is a bit difficult (me as a layman, my psych telling me, I know more about clonidine than he does). I have been diagnosed with adhd, cfs and ptsd. I am on vyvanse 50mg, which helped so much for the first weeks and then worsened my ptsd way too much. Now I'm taking 0,150mcg clonidine at night (it's been 2 weeks now) and I feel like it does nothing at all. The days with vyvanse are still not good. Would it be worth trying to combine them? To take clonidine WITH the vyvanse at the same time of day? I know you cannot give me medical advice, but some suggestions I could discuss with my psych would be so, so helpful 🙏
The important thing is to know which symptoms are not being targeted.
Cognition
Fight flight ( trauma related )
Activity
Sleep
Emotion - impulse control etc
When one says it does nothing - what is the target? Same with vyvanse. Medications are prescribed to address targets which then allows the individual to kick functioning and homeostasis into gear.
@@PsychiatrySimplified thank you so much! Vyvanse helped great for the "adhd-things". Focus, concentration, getting things done, not getting overwhelmed by sensory input and so on. I also had less fatigue and less pain and was not overthinking all the time. But then I started to get much more anxious, irritable, hypervigilant. Especially in the evenings, when vyvanse stops working, I could cry because of every small irritation. I hoped that clonidine could help with that issues. My sleep is "okay", I sweat a lot at night and don't feel rested in the morning, but I have no insomnia. At the moment I think I'll have to quit vyvanse, because I can find no professional here to figure it out with me and I can't stand the side effects longterm. This is sad, because for the first time of my life I felt good and "normal" for at least a few weeks...
@@PsychiatrySimplified don't know if it might useful for somebody, but I just wanted to share: reducing the dose to 0,0375 mcg twice daily seems to be much more effective in my case. Also had to reduce the dose of vyvanse. Still not perfect, but much better now.
I’m using Guanfacine to treat akathisia/agitation. Can Guanfacine help with hyper arousal? I’ve spoken to two others on Guanfacine to treat theirs as well. Would I be better off trying Clonodine? Currently no side effects from Guanfacine and just moved up to 3mg. Akathisia from Sertraline taper. Still taking 100mg. Guanfacine seems to be helping by reducing symptoms on most days by about 50% but they are still there and still get some bad flares. Working w my own doc and showing him some of your videos. Thanks!!
Good question. Clonidine has much greater presynaptic action and hence is better at reducing NA ( NA rebound is one of the aspects that occurs with SSRI reduction, cessation) . Guanfacine is more postsynaptic. In general clonidine is better atreducing hyperarousal. A very good indicator is guanfacine is doing what it should ( which it is to a certain bit -) is sleep - if vivid dreams or restless sleep is present then guanfacine is struggling to address the hyperarousal. If affective instability is present - mood swings, racing thoughts, associated then lamotrigine low dose helps in the withdrawal stage. Essentially it is about creating a synergy that is specific for the individual based on their symptoms. I am releasing a video in two weeks on the difference between anxiety vs hyperarousal vs agitation. Often akathisia can coexist with any of the above ( so becomes important to address those as they act as drivers of akathisia ) . Ps not medical advice
@@PsychiatrySimplifiedthanks for your response. I’ll talk to my doc about this. Most of what I dealt with has passed but been dealing with the extreme internal restlessness for about 21 months now. So just trying to address this bit. I have no idea if it’s hyper arousal, agitation, akathisia but it feels like bugs crawling and tickling my muscles and I cannot relax. Crazy inner uncomfortable tension but very very different from anxiety. And I don’t believe bugs are under my skin, to be clear, just this crawling sensation in my nerves and muscles. All started from Sertraline dose reduction. Guanfacine only makes me tired when increasing dose but once I get used to it I’m fine. Take in mornings, ER. Have had vivid dreams every night of my entire life and that hasn’t changed. But sleep isn’t usually restless. Once I go to sleep I’m usually out.
Vivid dreams indicate rem hyperarousal which can feed into the day. See video on insomnia - insomnia itself increases NA which itself is a mechanism in increasing akathisia. Sensory aspects as part of withdrawal also occur from partly increase NA - clonidine targets REM hypersrousal and is a evidence based treatment for akathisia. ( see video on akathisia) . If agitation is present it may need augmentation. The video in two weeks will provide some input. Wish you well.
@@PsychiatrySimplifiedI guess I don’t understand what “agitation” is. It’s got different definitions to different people. I’ll definitely check out the video when it comes out. Thanks!
Hi Sanil,
Generally speaking, are there any adverse long term effects of these 2 medications. Can a petite t safely take either of these 2 medications on a long term basis?
In general they are safe medications in the long term when prescribed by a medical professional in an appropriate manner .
Awesome
It’s a risk of rebound blood pressure if you skip a day or discontinue the medication abruptly?
Thank you
William
Adhd treatment trial one month duration. Vyvance 50mg daytime, clonidine 100mcg night time. Surprisingly a very difficult withdrawal from clonidine with akathisia symptom. Subsequent intolerance to starting an ssri when it was tolerated before clonidine. Low dose Mirtazapine with low dose ssri has not stopped akathisia from ssri. Even serotonin containing foods and b vitamins now seem to cause mild akathisia (use to occur when on ssri too). What receptor or neurotransmitter level changes might have occurred on clonidine and how might it be reversed? The clonidine dose may have been too high and not noticed as was taken at bedtime only. Would careful titration up on high dose Mirtazapine desensitise the excess alpha 1?? and help rebuild dopamine levels in stratium so ssri can be tolerated again to treat depression.
Sorry but it’s very difficult to say because 1. What were the original symptoms that were being targeted? 2. What improvements were noted with the initiation? 3. Were medications stopped suddenly? 4. What are the range of symptoms that are present currently? 5. What is the exact description of akathisia that is being experienced? These are the questions that you should discuss with your psychiatrist to explore the current situation.
@@PsychiatrySimplified1. brain fog, poor working memory, fatigue, focus/high distractabilty at non viral sick higher energy times, low motivation and reward - essentially ADHD inattentive I think? it just gets worse when sick in certain ways, better in others like distractability when sick. Thinking it's too much noradrenaline, too little dopamine. Both drop when sick with colds etc.. That is a guess.
2. brain fog, fatigue, motivation, reward but working memory did not and focus no better.
3. Vyvance only on 3 wks. vyvance stopped first, no taper. Clonidine on 4wks at single nightly dose 100mcg (day time use seemed to cancel out vyvance although was sick at time). Ceased clonidine with one week taper that was very difficult with akathisia and some mild anxiety.
5. inability to sit still, pacing, legs jiggling when seated, when lying down deep restlessness feeling in abdomen and moving around helps relieve/distract from? it.
Unfortunately psychiatrist does not suggest what to do because it is only bothersome when attempting to treat depression with ssri. Low dose Mirtazapine is tolerated. 30mg is as well (especially when sick which is too often!!) but serotonin foods can trigger mild symptoms of akathisia to reappear. Mirtazapine is not managing depression well despite sleep and anxiety greatly improved over 6 months. Moderate daytime jaw dystonia/clenching/teeth grinding in sleep also appears on ssri although that pre-existed before clonidine. Complicating factor is the frequency of colds as feels like noradrenaline and dopamine goes down significantly but then noradrenaline I think rebounds too high. Can clonidine be used sporadically for ADHD in my case? My hypertension is well controlled with Telmisartan.
Why is the clonidine stopped? The symptoms are suggestive of hyperarousal and combination of Vyvanse and SSRI can be activating. ( both have SERT inhibition) . Seems like there is underlying hyperarousal / agitation that needs to be addressed. Clonidine is effective in Mx hypertension , hyperarousal.
@@PsychiatrySimplified to ensure adhd symptom of distraction was not due to excess noradrenaline (but insufficient dopamine) clonidine 0.5mg was tried with vyvance 50mg during daytime but then vyvance did nothing then for brain fog. Vyvance lasts too long as liver enzyme slow to process thus clonidine at night was used to reverse it for sleep. Dextroamphetamine too rapid fall causing worse rebound depression.
**Dose might have been too high of clonidine but not perceived as it was during sleep and is that how it can cause ongoing need now for clonidine? it is too fatigue inducing to take however. Might be ok with ssri - never tried.
Uncertain if it's alpha 2 changed from clonidine but higher dose Mirtazapine doesn't seem to cause akathisia above 30mg. SSRI at any dose does when added to Mirtazapine or without Mirtazapine (on lamotrigine with ssri tho) brings on akathisia. *** Previous years on ssri (before lamotrigine or any adhd treatment), very mild akathisia was continuously experienced even well beyond initial 6 weeks on ssri.
It is possible the akathisia part of a mixed state agitation from ssri. Treatment of depression proving difficult so far. Is there any evidence clonidine with ssri is able to treat MDD Mixed state depression?
At a loss on how to treat depression so am about to try Auvelity (compounded similar version) as serotonin reuptake not as high as ssri. The bupropion component could help with ADHD as well. NMDA antagonism in lamotrigine doesn't seem to worsen things so hoping Auvelity will be tolerated too. A lower dose bupropion (due to slightly slow cyp2d6 genetically) might be key with dextromethorphan to be an effective nmda antagonist. Got them compounded separately for this reason.
That dose of clonidine is quite high! Usually targets include - sleep , cognition and activity. It’s difficult to know form here as I’m unclear with meds but wish you well with the treatment
Hi dr thank you so mush ..i am a doctor also but gastro enterologist...my son 9 years old have been dg with High profil of autisme ( he speaks , express , learn basket ball, withour routine or sleep issues) , for more 4 years he was en CBT and ABA , but lately we faced that he had also deficit of attention so its cause him anxiety and depression ...i learned bour clonidine , and now he is beein for 3 mounth with 0,1 mg he take ir at night...after too mounth he is more calme , vigilant , speak more , ...but i noticed that sometiles he had noseas and vomit ...and sometiles it goes and returnn..must i swetch to guafancine but i dont have it in morrocco...
Please answer me the right dose of clonidine 9 yeard 35 kg
It is difficult to provide individual thoughts as that would need a thorough assessment. In general nausea and vomiting may not be directly related to clonidine. BP should be checked. Children with Autism tend to have gut issues - so perhaps looking at alternative possibilities? If the nausea and vomiting is sporadic it is unlikely to be a medication side effect which tends to be persistent. PS not advice
@@PsychiatrySimplified thanks you so mush for taking Time to answer me ...your are righy , its sporadic , et yes he had nauseas many Time without clonidine ..my last question ( becaude WE dont have any neuropshychotric who use clonidine or guafancine )..in your expérience , your prefer clonidine or guafancine in child with hight profil autisme ..and thanks you so mush ?
And IS it possible to have an appointement with you online ? Thank you dr .
Clonidine is helpful to promote sleep, reduce anxiety, also in irritability , aggressive behaviours . Guanfacine can also do this but is better at improving cognition than sleep and reduction of arousal. Depending on what’s needed one can discuss this with the treating doctor. Sometimes if one doesn’t work for what’s needed the other one can be trialled. Sorry I don’t do online consultations . Wish you and your son well. Ps not advice
I am getting some joint pain and pins and needles from im assumingbtaking Guanfacine. Im taking 1 mg. Will this go away. Ive been on it for 11/2 weeks
It’s unusual ( listed as a rare side effect ) would recommend discussing this with your doctor .
I will. Thankyou for replying
It’s a risk of rebound blood pressure if you skip a day or discontinue the medication abruptly?
Thank you
William
Yes especially at higher doses. It’s advisable not to.
@@PsychiatrySimplified Thank you very much for replying. Just one more question.
Is 200 micrograms tconsidered a high dose?
No. Especially if BP is normal.
@@PsychiatrySimplified thanks again 🙏
So which one is better for adhd?
Depends on what one is trying to target. Clonidine acts presynaptically to reduce arousal so it’s usually prescribed in ADHD to assist with improvement in sleep.Guanfacine is postsynaptic and therefore has a better effect on promoting cognition with a little bit of reduction in arousal so ultimately depends on what one is trying to target so both can be very useful when matched with the right symptoms constellation.
How do you avoid hypotension whilst taking Clonidine?
Measure pre-existing BP . If low then it may not be suited. Clonidine does not result in precipitous drops when started slowly. It’s even used in POTS to stabilise BP.
@@PsychiatrySimplified Thanks
Patient with post covid cognitive impairment: Obviously clonidine must have an extremely high bioavailability else it wouldn’t have such a low concentration 100micrograms yes?
Indicator of potency I.e a small dose is needed for a effect.
More important than the bioavailability is the binding affinity for receptors in many cases. Not so much in the case of clonidine: for this drug, the comment by the channel's author is correct.
i learned nothing and understood nothing
Thanks for the feedback. Perhaps you many need to come back to the video after the basics of pharmacology as the video is intermediate to advanced
Any known male sexual dysfunction?
No significant risk reported in literature or identified in clinical practice. Mechanism of action does not fit either.