Guanfacine, sold under the brand name Tenex among others, is an oral medication used to treat attention deficit hyperactivity disorder (ADHD) and high blood pressure. Guanfacine is FDA-approved for monotherapy treatment of ADHD as well as being used for augmentation of other treatments, such as stimulants. Guanfacine is also used off-label to treat tic disorders, anxiety disorders and PTSD.Common side effects include sleepiness, constipation, and dry mouth. Other side effects may include low blood pressure and urinary problems. The FDA has categorized Guanfacine as "Category B"  in pregnancy which means animal-reproduction studies have not demonstrated a fetal risk or an adverse effect during pregnancy or breastfeeding. It appears to work by activating the α2A receptors in the brain thereby decreasing sympathetic nervous system activity.Guanfacine was approved for medical use in the United States in 1986. It is available as a generic medication. In 2019, it was the 140th most commonly prescribed medication in the United States, with more than 4 million prescriptions. Medical uses
Guanfacine is FDA approved as monotherapy or augmentation with stimulants to treat attention deficit hyperactivity disorder. It is also FDA approved to treat high blood pressure. It is FDA approved as monotherapy treatment for ADHD, and it is also FDA approved to be used in augmentation with stimulant medications when stimulants medications are not fully effective (stimulants include medications such as amphetamines and methylphenidate). Guanfacine can offer a synergistic enhancement of stimulant treatment for ADHD, and in many cases can also help control the side effect profile of stimulant medications.
Levoketoconazole, sold under the brand name Recorlev, is a steroidogenesis inhibitor that is used for the treatment of Cushings syndrome. Levoketoconazole was approved for medical use in the United States in December 2021.Levoketoconazole is the levorotatory or (2S,4R) enantiomer of ketoconazole, and it is an inhibitor of the enzymes CYP11B1 (11β-hydroxylase), CYP17A1 (17α-hydroxylase/17,20-lyase), and CYP21A2 (21-hydroxylase). It inhibits glucocorticoid biosynthesis and hence circulating levels of glucocorticoids, thereby treating Cushings syndrome. In addition to its increased potency, the drug is 12-fold less potent than racemic ketoconazole in inhibiting CYP7A1 (cholesterol 7α-hydroxylase), theoretically resulting in further reduced interference with bile acid production and metabolite elimination and therefore less risk of hepatotoxicity. Levoketoconazole has also been found to inhibit CYP11A1 (cholesterol side-chain cleavage enzyme) and CYP51A1 (lanosterol-14α-demethylase), similarly but more potently relative to ketoconazole. References
External links
"Levoketoconazole". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT03277690 for "A Study to Assess the Safety and Efficacy of Levoketoconazole in the Treatment of Endogenous Cushings Syndrome" at ClinicalTrials.gov
Clinical trial number NCT01838551 for "Treatment for Endogenous Cushings Syndrome (SONICS)" at ClinicalTrials.gov