Guanfacine for Treatment of Anxiety and Panic-Induced Vasovagal Syncope in the Intensive Care Unit.

This case report describes the successful use of oral guanfacine, a centrally acting alpha-2 agonist, for treating panic-induced vasovagal syncope in a 68-year-old intensive care unit (ICU) patient recovering from lung transplant and cardiac complications. The patient experienced recurrent episodes of severe anxiety and syncope triggered by physical therapy, unresponsive to standard anxiolytics. Guanfacine was chosen given its less pronounced cardiovascular effects and modulation of norepinephrine, and titrated over 10 days, leading to complete resolution of symptoms without adverse effects or recurrence. The patient resumed rehabilitation and guanfacine was successfully tapered prior to discharge. This case highlights guanfacine as a potentially useful anxiolytic option for ICU patients even with cardiovascular vulnerability as it exhibits less pronounced cardiovascular effects and may therefore be considered safer than other alpha-2 agonists.