Intuniv (Guanfacine ER) for ADHD

Intuniv (Guanfacine ER) for ADHD

Intuniv is the brand name for long acting guanfacine, or “Guanfacine ER”. Guanfacine is a central alpha 2a receptor agonist. Long acting guanfacine is a great choice for treating ADHD in all ages. Guanfacine can be used as stand-alone treatment for ADHD in clients for whom stimulants are not an option, or it can be used as adjunctive treatment in those clients already on a stimulant. It is so good it’s actually FDA approved as ADHD treatment in those age 6-17 (and the evidence for use in adults is also good!).

Dosing starts at 1mg and usually increases every 1-2 weeks until 3mg is reached. Goal doses are often 3 to 7mg total (4mg max in kids; 7mg max in teens/adults). You can take it in the AM but if it makes you tired you can take it at night. It’s long acting so it is only taken 1x per day. Unlike stimulants for ADHD, the benefits of guanfacine can take some weeks to be realized.

Unlike stimulants, it usually doesn’t have as many of the intense side effect that some get on stimulants, such as:

● Severe appetite suppression
● Severe irritability (only occurs in very rare cases, and usually it helps irritability)
● Insomnia
● High anxiety (in fact it often can help anxiety)
● Tics (in fact it can often help tics)

The biggest downside is that at higher doses (or when the dose is raised too quickly), people can have a lowering of blood pressure. This means that people can sometimes feel a little dizzy, especially when standing up quickly from a lying or seated position. This tends to be more of an issue in clients with perpetually low blood pressure or those with something called orthostatic hypotension (common in those who have POTS syndrome).

One way to monitor this is to watch your blood pressure every time you go up on the dose. A great blood pressure cuff from amazon can be found here: kId=ec5b34699a17021159bde54b09cc9e32&language=en_US#customerReviews

Here is the list of side effects-- as with any medication, please know them but please don’t get bogged down by the “what-ifs” (I like to point out that even common and “benign” medications like aspirin, taken by millions, have severe side effects listed like liver toxicity, kidney toxicity, stomach perforation, etc.)
Common side effects Sleepiness, drowsiness, dizziness, headache, irritability Low blood pressure Nausea, stomach pain, dry mouth, constipation and decreased appetite
With low blood pressure there is a risk of syncopal/fainting episodes.
There are very rare case reports of tactile or auditory hallucinations.


David Danish MD

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