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Guanfacine ER for ADHD is usually started and monitored by a psychiatrist, as it requires proper assessment, dose titration, and follow-up for side effects like blood pressure changes and sedation. While an MD physician may be aware of the medication, initiating it specifically for ADHD without psychiatric evaluation is generally not recommended. It would be best to consult a psychiatrist at least once even at a government setup to confirm diagnosis and start treatment safely.