Dr. John Kruse

So Intuniv, the brand name extended release guanfacine, was approved in kids, because again, most of the research on ADHD is still in kids, for treating ADHD as a solo agent. It clearly works in adults as well. And even before Intuniv was approved, there were a handful of studies with either immediate-release guanfacine or extended-release guanfacine.

In the studies so far, the results aren't distinguishable. They both seem to work. So clinically, because it's much cheaper, I actually use... immediately release form, and all at bedtime. And again, because my impression, and I probably don't have an end that's big enough to do a rigorous study, is the sedating effects are relegated to the nighttime and people are feeling okay during the daytime.

In the studies so far, the results aren't distinguishable. They both seem to work. So clinically, because it's much cheaper, I actually use... immediately release form, and all at bedtime. And again, because my impression, and I probably don't have an end that's big enough to do a rigorous study, is the sedating effects are relegated to the nighttime and people are feeling okay during the daytime.

In the studies so far, the results aren't distinguishable. They both seem to work. So clinically, because it's much cheaper, I actually use... immediately release form, and all at bedtime. And again, because my impression, and I probably don't have an end that's big enough to do a rigorous study, is the sedating effects are relegated to the nighttime and people are feeling okay during the daytime.

I mean, some of the rationale with the extended release is you're sort of smearing it over a longer time, so it should be less sedating. But depending on the time curve and how it works, you could actually wind up with being more uniformly sedated day and night with the extended release. So I've seen good results in some people.

I mean, some of the rationale with the extended release is you're sort of smearing it over a longer time, so it should be less sedating. But depending on the time curve and how it works, you could actually wind up with being more uniformly sedated day and night with the extended release. So I've seen good results in some people.

I mean, some of the rationale with the extended release is you're sort of smearing it over a longer time, so it should be less sedating. But depending on the time curve and how it works, you could actually wind up with being more uniformly sedated day and night with the extended release. So I've seen good results in some people.

I've had many who either didn't work or they didn't perceive a result because, again, some part for some people of the stimulant benefit is... I can feel it. I know it's working.

I've had many who either didn't work or they didn't perceive a result because, again, some part for some people of the stimulant benefit is... I can feel it. I know it's working.

I've had many who either didn't work or they didn't perceive a result because, again, some part for some people of the stimulant benefit is... I can feel it. I know it's working.

So the majority, at least in terms of prescription searches and what clinics tend to be, it looks like most people who are on guanofacine are on it in combination with either a stimulant or a norepinephrine or dopamine-promoting agent.

So the majority, at least in terms of prescription searches and what clinics tend to be, it looks like most people who are on guanofacine are on it in combination with either a stimulant or a norepinephrine or dopamine-promoting agent.

So the majority, at least in terms of prescription searches and what clinics tend to be, it looks like most people who are on guanofacine are on it in combination with either a stimulant or a norepinephrine or dopamine-promoting agent.

So we're going to jump back to your issue with the recency in science and how to incorporate things. When some Modafinil was a drug developed by a French company and approved there and used for decades, for maybe a decade before it came to the U.S. 25, maybe 35 years ago. And at the time, all the research showed that it was an orexin receptor that antagonist. Antagonist, agonist.

So we're going to jump back to your issue with the recency in science and how to incorporate things. When some Modafinil was a drug developed by a French company and approved there and used for decades, for maybe a decade before it came to the U.S. 25, maybe 35 years ago. And at the time, all the research showed that it was an orexin receptor that antagonist. Antagonist, agonist.

So we're going to jump back to your issue with the recency in science and how to incorporate things. When some Modafinil was a drug developed by a French company and approved there and used for decades, for maybe a decade before it came to the U.S. 25, maybe 35 years ago. And at the time, all the research showed that it was an orexin receptor that antagonist. Antagonist, agonist.

Works on the orexin system. The hypocretin orexin system, right. So boosting activity, but not working like all of our stimulant alerting drugs, which are working on primarily norepinephrine systems. So it was called the non-stimulant stimulant. Now most of the

Works on the orexin system. The hypocretin orexin system, right. So boosting activity, but not working like all of our stimulant alerting drugs, which are working on primarily norepinephrine systems. So it was called the non-stimulant stimulant. Now most of the

Works on the orexin system. The hypocretin orexin system, right. So boosting activity, but not working like all of our stimulant alerting drugs, which are working on primarily norepinephrine systems. So it was called the non-stimulant stimulant. Now most of the

Pharmacology literature refers to it as a dopamine-acting drug, and some people are debating whether it's orexin that it's working via or dopamine. I haven't seen anything that to me gives a clear consensus. So I stick with the orexin because that's where I was taught.