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Peer-reviewedCC BY-NC-NDPaediatrics & child health

Extended-release guanfacine overdose in a pediatric emergency department: a systematic review and a 10-year retrospective chart review

  • Oluwatobi Mohammed1,2
  • Christopher Chu3
  • Darsh Shah3
  • Nuri Song4
  • Imali Gamage5
  • Redjana Carciumaru1
  • Rebecca Chauhan6
  • April J Kam1
6 affiliations
  1. 1Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
  2. 2Mary Heersink School of Global Health and Social Medicine, McMaster University, Hamilton, ON, Canada.
  3. 3Department of Medicine, McMaster University, Hamilton, ON, Canada.
  4. 4Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  5. 5Department of Family Medicine, St Joseph's Hospital and SUNY Health Science, Syracuse, NY, USA.
  6. 6Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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Abstract

Objective

To characterize clinical presentations, management strategies and outcomes associated with extended-release guanfacine (ER guanfacine) overdose in pediatric patients presenting to a tertiary care pediatric emergency department (ED) supplemented with a systematic review of published pediatric cases.Methods

A retrospective chart review included patients aged 0 to 18 years presenting with guanfacine overdose to a tertiary pediatric ED between August 2013 and July 2023. Data were extracted on demographics, cause of overdose, clinical features, management and outcomes. Concurrently, a systematic review using the population, exposure, and outcome approach searched MEDLINE and Embase (1974-November 2025) to consolidate existing case-report evidence on emergent management of guanfacine overdose in pediatric patients.Results

Ten studies met inclusion criteria, describing eleven pediatric cases, mostly accidental with ingestions in younger children, with bradycardia and hypotension reported frequently.Management was supportive; naloxone produced variable benefit, and when used no deaths occurred. For the retrospective cohort, (n = 15; median age 14), 73% involved intentional ingestions and were frequently associated with psychiatric comorbidities. Bradycardia and hypotension were nearly universal; with some patients demonstrating transient hypertension. Treatment included intravenous fluids (87%) and atropine for symptomatic bradycardia (20%). Three patients required pediatric intensive care unit admission; none received naloxone. All patients recovered fully without mortality.Conclusion

ER guanfacine overdose most commonly affects adolescents with underlying mental health conditions and presents with clinically significant cardiovascular depression. Management is supportive, emphasizing fluid resuscitation and cardiac monitoring. Findings support the need for standardized ED care pathways and integrated mental-health interventions.

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Cite

BibTeXRIS
BibTeX
@article{mohammed2026extendedrelease,
  title = {{Extended-release guanfacine overdose in a pediatric emergency department: a systematic review and a 10-year retrospective chart review}},
  author = {Oluwatobi Mohammed and Christopher Chu and Darsh Shah and Nuri Song and Imali Gamage and Redjana Carciumaru and Rebecca Chauhan and April J Kam},
  journal = {Paediatrics \& child health},
  year = {2026},
  month = jul,
  doi = {10.1093/pch/pxag051},
  url = {https://europepmc.org/article/PMC/PMC13727080},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Extended-release guanfacine overdose in a pediatric emergency department: a systematic review and a 10-year retrospective chart review
AU  - Oluwatobi Mohammed
AU  - Christopher Chu
AU  - Darsh Shah
AU  - Nuri Song
AU  - Imali Gamage
AU  - Redjana Carciumaru
AU  - Rebecca Chauhan
AU  - April J Kam
PY  - 2026
DA  - 2026/07/10
JO  - Paediatrics & child health
DO  - 10.1093/pch/pxag051
UR  - https://europepmc.org/article/PMC/PMC13727080
AB  - Objective  To characterize clinical presentations, management strategies and outcomes associated with extended-release guanfacine (ER guanfacine) overdose in pediatric patients presenting to a tertiary care pediatric emergency department (ED) supplemented with a systematic review of published pediatric cases.Methods  A retrospective chart review included patients aged 0 to 18 years presenting with guanfacine overdose to a tertiary pediatric ED between August 2013 and July 2023. Data were extracted on demographics, cause of overdose, clinical features, management and outcomes. Concurrently, a systematic review using the population, exposure, and outcome approach searched MEDLINE and Embase (1974-November 2025) to consolidate existing case-report evidence on emergent management of guanfacine overdose in pediatric patients.Results  Ten studies met inclusion criteria, describing eleven pediatric cases, mostly accidental with ingestions in younger children, with bradycardia and hypotension reported frequently.Management was supportive; naloxone produced variable benefit, and when used no deaths occurred. For the retrospective cohort, (n = 15; median age 14), 73% involved intentional ingestions and were frequently associated with psychiatric comorbidities. Bradycardia and hypotension were nearly universal; with some patients demonstrating transient hypertension. Treatment included intravenous fluids (87%) and atropine for symptomatic bradycardia (20%). Three patients required pediatric intensive care unit admission; none received naloxone. All patients recovered fully without mortality.Conclusion  ER guanfacine overdose most commonly affects adolescents with underlying mental health conditions and presents with clinically significant cardiovascular depression. Management is supportive, emphasizing fluid resuscitation and cardiac monitoring. Findings support the need for standardized ED care pathways and integrated mental-health interventions.
SN  - 1205-7088
SN  - 1918-1485
ER  -