When do you use guanfacine instead of stimulant medication for adults with ADHD?

The short answer is that it just doesn't address the executive dysfunction experienced by most adults with ADHD who seek treatment. Adults who have that "hyperactive edge" about them (impulsive speech, interrupting, rapid topic changes, fidgeting) or who have significant irritability/aggression can ...

The premise that guanfacine could simply replace stimulants due to its non-controlled status misrepresents the complexity of adult ADHD. ADHD is a heterogeneous neurodevelopmental disorder, and treatment must address distinct, often overlapping, neurobiological pathways. Stimulants and non-stimulant...

I use it fairly often, but almost always in combination with another agent. For most adults, it simply does not work as a monotherapy.

The question seems to imply that risk-aversion should be the primary driver of medication selection. We have to counter this with a consideration of overall efficacy...