{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T14:29:55Z","timestamp":1775140195880,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe the frequency, severity, management and complications of guanfacine exposures in paediatric and adolescent patients referred to a state Poisons Information Centre or presenting to two EDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicentre, retrospective review of guanfacine exposures from July 2017 to October 2023 in patients aged \u226419\u2009years that were discussed with the Victorian Poisons Information Centre or presented to the Royal Children's Hospital or Austin Health EDs, Melbourne. Demographic, clinical, management and outcome data were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 275 guanfacine exposures reported to the Poisons Information Centre, with a 16\u2010fold increase in exposures over the study period. Of these, 173 (63%) were unintentional therapeutic errors, the majority (103) involving accidental double\u2010dosing. Twenty\u2010four cases presented to either of the study EDs and 38 cases from other hospitals were discussed with a clinical toxicologist. Of these 62 cases with a medical assessment, 32 reported lone guanfacine exposure. Hypotension, bradycardia and drowsiness were present in 9\/32, 17\/32 and 13\/32 cases, respectively. Five (16%) patients received i.v. fluids. No patients required intubation, inotropic or vasopressor support. One patient who was co\u2010exposed to marijuana required atropine. Prolonged orthostatic hypotension was observed in three of 32 cases, lasting a median of 36\u2009h (range 24\u201342\u2009h).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Paediatric guanfacine exposures increased significantly over the study period. Isolated guanfacine ingestions were well tolerated, seldom requiring specific intervention. Clinicians need to be cognisant of the risk of prolonged orthostatic hypotension, and this must be excluded prior to discharge.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.70018","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T20:57:57Z","timestamp":1741726677000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Guanfacine exposure in paediatric and adolescent patients: A multicentre retrospective review"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0372-2778","authenticated-orcid":false,"given":"Emma","family":"Peters","sequence":"first","affiliation":[{"name":"Emergency Department Royal Children's Hospital  Melbourne Victoria Australia"},{"name":"Emergency Department Austin Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4649-1813","authenticated-orcid":false,"given":"Sarah E","family":"Hodgson","sequence":"additional","affiliation":[{"name":"Emergency Department Austin Health  Melbourne Victoria Australia"},{"name":"Victorian Poisons Information Centre Austin Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7750-9724","authenticated-orcid":false,"given":"Rohan","family":"Elliott","sequence":"additional","affiliation":[{"name":"Pharmacy Department Austin Health  Melbourne Victoria Australia"},{"name":"Faculty of Pharmacy and Pharmaceutical Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7423-2467","authenticated-orcid":false,"given":"Shaun L","family":"Greene","sequence":"additional","affiliation":[{"name":"Emergency Department Austin Health  Melbourne Victoria Australia"},{"name":"Victorian Poisons Information Centre Austin Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004867415617836"},{"key":"e_1_2_9_3_1","unstructured":"Department of Health Therapeutic Goods Administration.Australian Public Assessment Report for Guanfacine (as Hydrochloride).2018. [Cited 3 Sept 2024.] Available from URL:https:\/\/www.tga.gov.au\/sites\/default\/files\/auspar\u2010guanfacine\u2010180503"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-013-0084-8"},{"key":"e_1_2_9_5_1","volume-title":"Goldrank's Toxicological Emergencies","author":"Hoffman RS","year":"2015"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2019.1605076"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2014.0022"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.27.9.1253"},{"key":"e_1_2_9_9_1","volume-title":"Australian Medicines Handbook 2020","author":"Australian Medicines Handbook","year":"2020"},{"key":"e_1_2_9_10_1","first-page":"256","article-title":"Guanfacine toxic ingestion with subsequent cardiogenic pulmonary oedema","volume":"39","author":"Bridwell RE","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"e_1_2_9_11_1","article-title":"Delayed signs and symptoms of extended release guanfacine overdose in two adolescent patients: implications of monitoring on the psychiatric unit","author":"Mishra S","year":"2022","journal-title":"Case Rep. Psychiatry"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/24734306.2021.1878322"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563650903505174"},{"key":"e_1_2_9_14_1","unstructured":"New Zealand National Poisons Centre.Guanfacine. TOXINZ.2024. [Cited 4 Sept 2024.] Available from URL:https:\/\/www.toxinz.com.acs.hcn.com.au\/specifications\/alpha\u20102\u2010adrenergics\u2010\u2010\u2010imidazolines\/imidazolines\u2010\u2010\u2010antihypertensives\/imidazoline\u2010antihypertensives\u2010\u2010\u2010guanidines\/guanfacine\/?&name=Guanfacine"},{"key":"e_1_2_9_15_1","unstructured":"National Poisons Information Service.Guanfacine. TOXBASE.2024. [Cited 4 Sept 2024.] Available from URL:https:\/\/www.toxbase.org\/poisons\u2010index\u2010a\u2010z\/g\u2010products\/guanfacine\/#Links"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.70018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T04:14:02Z","timestamp":1747368842000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.70018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1111\/1742-6723.70018"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.70018","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"value":"1742-6731","type":"print"},{"value":"1742-6723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]},"assertion":[{"value":"2024-10-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70018"}}