Clinical Snapshot
Hallucinations While Using Guanfacine in ADHD
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In a 9-year-old boy with simple attention deficit hyperactivity disorder (F90.0 G), methylphenidate (15 mg) was supplemented with guanfacine (1 mg) due to side effects of and lack of response to first- and second-line treatment (methylphenidate up to 20 mg: loss of appetite and headaches, lisdexamfetamine up to 20 mg: dysphoria). Within only a few days, visual and acoustic hallucinations occurred, initially at night but later also during the day, lasting between several minutes and 1 h (machinery noises, colorful objects on the ceiling, (Figure). The boy found these hallucinations very frightening. Following discontinuation of all medications, the symptoms ceased within 24 h. After a 1-week treatment pause, guanfacine was administered once again as monotherapy (1 mg) with a good initial effect. Since the hallucinations recurred, treatment was discontinued; this was followed by a renewed remission. With regard to psychotic disorders, there were no known abnormalities in the patient or family history. Although hallucinations with guanfacine are an unusual—and rarely published—side effect in children, they are not unheard of with alpha-2 receptor agonists in general. Due to their relevance and the fact that parents and children may not recognize them, they should be addressed during patient education and follow-up.
Prof. Dr. med. Judith U. Harrer-Haag, Neurologische Praxis Villa Pfahler, St. Ingbert und Klinik und Poliklinik für Neurologie, Universitätsklinikum der RWTH Aachen, judith.harrer@web.de
Dr. med. Anette Voran, Praxis für Kinder- und Jugendpsychiatrie und Psychotherapie, Zweibrücken
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Harrer-Haag JU, Voran A: Hallucinations while using guanfacine in ADHD. Dtsch Arztebl Int 2024; 121: 739. DOI: 10.3238/arztebl.m2024.0088
