(PO-099) Guanfacine, an old drug with new tricks? Anxiolysis in lung transplant.
For the lung transplant patient, physical and psychological symptoms of anxiety are especially difficult to treat as a result of the risk for delirium, respiratory depression, drug interactions, and limited pharmacologic options with quick onset. Guanfacine, a potent centrally-acting alpha-2 agonist, may provide a safe and effective alternative.
Literature review of the anxiolytic and pharmacologic properties of guanfacine with a brief case presentation.
Case: 48-year-old female status post lung transplant with refractory anxiety in the setting of perceived dyspnea and treatment with olanzapine, venlafaxine, and gabapentin. Anxiety improved and psychotropic PRN frequency decreased with up-titration of guanfacine.
Anxiety is common for lung transplant patients, it is associated with worse outcomes, and the options for effective pharmacologic treatment are limited. Guanfacine may provide an advantageous alternative because 1) it is not associated with respiratory depression or delirium, a crucial difference with the commonly prescribed benzodiazepines; 2) it appears to have a favorable side-effect and drug-interaction profile, especially important in patients with complex medication regimens including lifetime immunosuppressive and antibiotic therapy; 3) there is accumulating evidence for the safe use of this medication in the acutely medical ill; 4) it has the potential benefit of modulating visceral pain; and 5) guanfacine has a quicker onset of action in comparison with most other agents.
Guanfacine warrants further consideration and investigation as an anxiolytic agent in hospitalized lung transplant patients.
Courtwright AM, et al. The association between mood, anxiety and adjustment disorders and hospitalization following lung transplantation. General Hospital Psychiatry. 2016.
Kim J, et al. Use of Guanfacine as an alternative to Dexmedetomidine for sedation and agitation management in the Intensive Care Unit. Journal of Psychosomatic Research. 2020; 110062.
Srour H, et al. Enteral Guanfacine to Treat Severe Anxiety and Agitation Complicating Critical Care After Cardiac Surgery. Seminars in Cardiothoracic and Vascular Anesthesia. 2018;22(4):403–6.
Strawn JR, et al. Extended Release Guanfacine in Pediatric Anxiety Disorders: A Pilot, Randomized, Placebo-Controlled Trial. Journal of Child and Adolescent Psychopharmacology. 2017;27(1):29–37.
Sabetkasaie M, et al. Clonidine and guanfacine-induced antinociception in visceral pain: possible role of alpha 2/I2 binding sites. Eur J Pharmacol 2004;501(1e3):95e101.
Consider the role of guanfacine as an adjunctive anxiolytic in the lung transplant patient population.
Review the literature on guanfacine's anxiolytic properties.
Review pharmacological properties of guanfacine that makes it a good candidate in the lung transplant patient population.