ADHD Medication and Treatment Reviews

Guanfacine: Non-Stimulant Medication for ADHD

Guanfacine HCL is a non-stimulant medication used to treat symptoms of attention deficit hyperactivity disorder ADHD/ADD). It is typically used alone but sometimes prescribed with a stimulant as a complementary treatment therapy.
Brand Name: Intuniv, Tenex

Does Guanfacine Work for ADHD?

Guanfacine (Brand Name: Intuniv, Tenex) is a non-stimulant prescription ADHD medication used to treat attention deficit hyperactivity disorder (ADHD or ADD). It’s most often used alone but in some cases it is used in combination with stimulant ADHD medications.

Guanfacine is thought to interact with receptors in the brain in a way that improves ADHD symptoms such as distractibility, executive functioning, and impulse control

Non-stimulant medications like guanfacine can be helpful for patients with ADHD who can’t take stimulants due to undesirable side effects or who don’t experience any benefits from them. People with certain medical conditions (such as low blood pressure and cardiac abnormalities) or substance abuse problems may also not be good candidates for this medication.

Unlike some stimulant medication, guanfacine is not a controlled substance and does not have a high risk of abuse or dependency.

Intuniv is an extended-release (ER) formula of guanfacine. Currently, guanfacine ER is FDA approved only for use in children who are 6 through 17 years old. It has not been studied in children younger than the age of 6.

The immediate-release formulation of guanfacine (the Tenex brand) is used to treat high blood pressure. Its safety has not been studied in children under age 12.

Is Guanfacine the Same Thing as Adderall?

No. Guanfacine and Adderall are very different medications. Both must be prescribed by a doctor and can be used to treat ADHD but have different side effects and work in the body in different ways. Adderall is a popular stimulant medication that can be prescribed to children over 3 years of age and works to control hyperactivity and impulsive behavior. It treats inattention, impulsivity, lack of focus, disorganization, forgetfulness or fidgeting.

Guanfacine is most often prescribed when stimulant medication fails either due to too many negative side effects or a lack of symptom improvement. Adderall is a combination medication made up of amphetamine and dextroamphetamine that is also available in a generic form. The FDA has approved a generic version of both the immediate-release (Adderall IR) and extended-release (Adderall XR) versions.

Adderall has been classified by the Drug Enforcement Agency (DEA) as a “Schedule II” medication. Schedule II medications are drugs with a high potential for abuse.  Another downside of Adderall is that taking it can be habit-forming. Guanfacine is in a class of drugs known as centrally acting alpha2A-adrenergic receptors.

What Is the Best Dosage of Guanfacine for Treating ADHD?

Before starting or refilling a guanfacine prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor. Your doctor can review you or your child’s medical history, other diagnoses, and other prescriptions for possible interactions and take into account other important considerations. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

As with all medications, follow your guanfacine prescription instructions exactly.

Guanfacine is available in two formulations:

  • Immediate-Release Tablet: (Brand Name: Tenex) Taken up to twice daily. Available in 1mg or 2mg dosages.
  • Extended-Release Tablet: (Guanfacine ER, Brand Name: Intuniv) Taken once daily in the morning or evening at approximately the same time each day. Tablets are available in 1mg, 2mg, 3mg, and 4mg dosages.

Guanfacine should not be taken with a high-fat meal. This can speed up the release of medication, and increase the risk of side effects. Tablets should be swallowed whole with water or other liquids, and never crushed or chewed.

The optimal dosage varies patient by patient and by the condition being treated. Your doctor may adjust your dosage weekly by 1mg increments until you or your child experience the best response. The right dose is the one with that gives you (or your child) the most improvement in symptoms without side effects (or with the fewest).

If you miss a dose, you should take it as soon as possible, unless it is already time for your next dose. You should not take two doses of guanfacine at the same time. Contact your doctor if you have questions about skipped pills.

Do not drink alcohol while taking this drug.

When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication by no more than 1mg every 3 to 7 days. Stopping guanfacine suddenly can create withdrawal symptoms including increased heart rate and high blood pressure, sometimes accompanied by headaches, confusion, agitation, or tremors.

What Side Effects are Associated with Guanfacine?

The most common side effects of guanfacine are sedation, tiredness, difficulty sleeping, low blood pressure, nausea, stomach pain, dizziness, dry mouth, irritability, vomiting, and slow heart rate.

Serious side effects include low blood pressure or heart rate, fainting, sleepiness, or withdrawal symptoms. Taking guanfacine may impair your or your teenager’s ability to drive, operate machinery, or perform other potentially dangerous tasks. If side effects are bothersome or continue to persist, talk to your doctor. Most people taking this medication do not experience any of these side effects.

Report to your doctor any heart-related problems or a family history of heart and blood pressure problems. Patients with structural cardiac abnormalities, renal failure, and serious heart problems could experience complications while taking guanfacine. Physicians should monitor vital signs closely during treatment. Call your doctor immediately if you or your child experience warning signs such as chest pain, shortness of breath, or fainting while taking guanfacine.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

What Precautions are Associated with Guanfacine?

  • Store guanfacine in a secure place out of the reach of children, and at room temperature.
  • Do not share your guanfacine prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.
  • You should not take guanfacine if you have an allergy to guanfacine or any of its ingredients.
  • Proceed with caution if you have kidney problems, a history of fainting, heart problems, or a history of stroke.
  • Avoid becoming overheated or dehydrated while taking guanfacine.
  • If you’re thinking of becoming pregnant, discuss the use of guanfacine with your doctor. Animal studies indicate a potential risk of fetal harm.
  • It is not known if guanfacine is passed through breastmilk, so nursing mothers are usually instructed not to take this medication.

What Should I Know Before Taking Guanfacine?

Be sure and discuss all other active prescription medications with your doctor. Guanfacine can cause dizziness and exacerbate the drowsiness created by depressants including alcohol, barbiturates, antihistamines, or other sedatives.

It’s also important to share information about all vitamin or herbal supplements (especially St. John’s wort), and non-prescription medications (acetaminophen, ibuprofen, etc.) you take with the pharmacist when you fill your prescription and let healthcare providers know you are taking guanfacine before undergoing surgery or having lab tests.

Note: The information in this article is not a complete list of all possible drug interactions.

Sources:

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6fdcebac-0a5a-4858-b0e6-87f77ba53bf1
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=301f01a7-2b0a-cfba-9c3d-a1dd831785a3
http://pi.shirecontent.com/PI/PDFs/guanfacine_USA_ENG.pdf

More Information on Guanfacine and Other ADHD Medications:

Free Download: Take Charge of Your Child’s Medication
Intuniv: Answers to Your ADHD Medication Questions
Free Resource: How Do We Know the Medication Is Working?

10 Guanfacine: Non-Stimulant Medication for ADHD Related Links

  1. My 13 year-old son started taking Tenex (Guanfacine) several months ago, in addition to his Adderrall XR.

    Our doctor prescribed it because my son was experiencing severe facial/motor tics and Tenex is thought to help them. I was pleasantly surprised with it because in addition to tapering off his tics, it worked really well in combo with the Adderall in respect to his focus and behavior at school.

    The one thing is that I gave it to him without the Adderall a few times and and he got sleepy. The bottle says to give it to him at night, but my doctor told me I could try it in the morning. With Adderall, it doesn’t make him sleepy at all so I typically give it to him in the morning.

    Lastly, he started off on 1 mg & is now on 2 mg.

  2. My son took Tenex for a while in addition to his stimulants. The goal was to keep the stimulant effective (it stopped working every six weeks) without giving the maximum dose. It didn’t meet that goal so he ended up stopping Tenex.

    Intuniv is simply a long-acting preparation of Tenex. Here’s an FAQ on this medication.
    Penny
    ADDconnect Moderator, Author on ADHD, and Mom to Pre-Teen Boy w/ ADHD and LDs

  3. My son has been on a ton of medications in 2 years. We finally landed on Vyvanse in the morning and Tenex at night. So far it has worked. It is a roller coaster ride.

  4. The first medication my 7 year-old son tried was guanfacine. He has been diagnosed ADHD with signs of anxiety so we wanted to start with a non-stimulant because of the anxiety. Taking it in the morning made him so sleepy he could not function and would fall asleep at his desk at school. Taking it at night solved the sleep problem but we didn’t see any changes in behavior after about 2 months and discontinued it. He is now taking Strattera which is another non-stimulant. He’s been taking it for 2 months with no negative side effects and we’re starting to see some small positive changes in his behavior but what we’re trying to address is his inability to focus and stay on task at school; since school is out it tough to say if it’s truly working.

  5. My ten year old daughter recently started on generic guanfacine, without stimulants. She started with a half a one mg tablet. A lot of problems with drowsiness the first few days and then seemed to mellow out, but I couldn’t tell if there was any difference in behavior. We upped the dosage to 1 mg last week and are back to the drowsiness in extreme. She is like a zombie and hates feeling the way she does. She is having a HARDER time paying attention in class because she is so sleepy. I don’t like seeing her that way. I guess we could try taking it at night instead, but not sure what to do because the generic is “short acting” and she is supposed to take two pills, one in the morning and one at lunch.

  6. My 12 yr old son has ADHD (combined type) and also Tourette’s Syndrome. He cannot take any stimulants as they are very well known for bringing tics out in some kids. Since my son already has Tourette’s, we have to avoid those. He was taking Intuniv (long acting Guanfacine) for about 4 years which worked wonderfully for both tics and ADHD symptoms. Since starting puberty the Intuniv wasn’t working as well. We have changed him over to Strattera(80mg) and that seems to be working out great for him.

    Oh! Almost forgot. The Intuniv did cause some extreme sleepiness with my son. The Strattera is not doing that at all. I was told years ago by one of his doctors that puberty would be a trying time and would probably require some medication changes.

  7. I’ve had great luck with guanfacine. High blood pressure meant that my ARNP took me off Focalin. I started on Intuniv with a coupon, but I’ve been happy with the inexpensive short acting guanfacine as well. Works to keep me calm, less frustrated and antsy. I even get things done, but it’s the relief from stress and anxiety which I enjoy the most.

  8. We started with a 1 mg dose in the morning and then upped it to 2 mg. When we changed to 2 mg, we noted that our 7-year-old was EXTREMELY tired to the point of needing to nap immediately after he came home from school. At the doctor’s suggestion, we split the dose into 1 mg in the morning and 1 mg at night and have not had further issues. Our son also has Tourette syndrome, and this was very effective in lessening his tics. We found it did not do enough to remediate issues of focus and impulsivity, however, and have since added Strattera to his regimen. The two medications seem to be working well together, and he has an improvement in his symptoms.

  9. My 4 y/o has been on yhis med for 1 month. Started on 3/4 of the pill but now i am on the entire pill (1mg). I give my son the pill at 5am so it can go into effect by 7:30 am when he starts school. Yes, he was a bit groggy initially; however, it now appears he is groeing out of the 1mg dose. This med has DEFENITELY helped with his outbursts and to get him to his baseline. I am about to do the Genomind (genetic testing) to help me figure out what meds are most compatible with my childs DNA to avoid the long trial/error process.

  10. 6yr old son was prescribed 1mg (.5mg in AM, .5 in PM) for ADHD. He was a little drowsy at first but it wore off, week 2 we thought it was a miracle drug – he was less impulsive, able to sit and play independently, getting good reports from school, less hyperactive, but still himself. Unfortunately by week 3 all the positive effects had worn off and we were right back to baseline. Doctor had us increase to 2mg (1 morning, 1 night) and it was a nightmare. Total zombie, wouldn’t play at all just sat and stared, sad and tearful, looked ill, complained of chest and tummy pains, complete insomniac, developed more anxiety, these effects never wore off while on the med and after a few more weeks of trying, including going back down to 1mg for awhile with no positive results, we determined this just isn’t the right med for him.

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