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Attention Deficit Hyperactivity Disorder

Adderall and Tenex

01/28/1999

Question:

Are there any possibly serious side effects with treating ADHD with the drugs Guanfacine(generic for Adderall) and Tenex combined? Previously, I had identified Guanfacine as the generic for Tenex. That was a mistake. I understand that Tenex is only approved for high blood pressure.

Answer:

The answer to the question "Are there ANY POSSIBLE serious side effects with..." any two drugs is almost always "yes". HOWEVER, the LIKELIHOOD of major side effects between guanfacine (Tenex) and Adderall (no easy generic name since it is made up of four different dexedrine-related salts) is almost zero. The main drug-drug interactions program in the physicians-only online network, Physicians Online, states there are no known interactions. What is probably more important to know is that ADD specialists and psychiatrists in general have been using this combination for many years and I know of no major reactions reported. However, I think it is important to never prescribe either drug, alone or together, without careful patient education and followup of blood pressure and pulse.

Regarding your note that guanfacine is only approved for blood pressure, you are correct. As I began practicing medicine many years ago I was surprised to find out that physicians use many, many drugs for medical problems that the drugs are not officially "indicated" for. "Indications" generally refers to those medical problems that the drug company requested the Federal Drug Administration (FDA) approve, and that the FDA felt there was approriate evidence for. The evidence is generally submitted by the company, so the drug companies, in effect, often have more say in what officially is labeled an "indication" than physicians in practice. However, once a drug is released, physicians are allowed to use it whenever we feel it is indicated. A year ago, at a national ADD conference, one of the doctors from Harvard mentioned that 60% of drugs used in children (ALL drugs, not just those for ADD) did not have official pediatric indications. Fortunately, the FDA now appears to be putting more emphasis on insisting that, when companies apply for marketing of new drugs that are likely to be used in kids, they submit evidence about what they do in pediatric patients. GREAT (important) question, thanks.

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati