3. Duplicative Therapy

The use of two or more psychostimulants concurrently for ADD/ADHD management is not justified. Additional therapeutic benefit is not realized when ADHD stimulant medications are used in combination. Additionally, guanfacine extended-release tablets should not be prescribed concurrently with other guanfacine-containing products due to increased risks of additive pharmacologic/adverse effects, including hypotension. Extended-release guanfacine and extended-release clonidine have supporting evidence and FDA approval for use as adjunctive therapy with stimulant medications. Additionally, there is limited evidence supporting the efficacy and safety of using atomoxetine as adjunctive therapy to stimulant medications in the management of ADHD.42 Patient profiles documenting receipt of multiple ADHD medications or multiple guanfacine-containing products will be reviewed.