ADHD Medication and Treatment Reviews

Guanfacine: ADHD Medication

Guanfacine HCL is a non-stimulant medication used to treat ADHD symptoms for patients aged 13 and older.
Brand Name: Intuniv, Tenex

What Is Guanfacine? What Does Guanfacine Do for ADHD?

Guanfacine (brand Name: Intuniv, Tenex) is a non-stimulant prescription 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 ADHD medications like guanfacine can be helpful for patients 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 ADHD medications, 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 ADHD medications. Both must be prescribed by a doctor and can be used to treat ADHD symptoms but have different side effects and work in the body in different ways. Adderall is a popular stimulant medication that can be prescribed to patients 6 years and older 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 ADHD 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. Adderall can be habit-forming. Guanfacine is in a class of drugs known as centrally acting alpha2A-adrenergic receptors that is not known to be habit-forming.

What Is the Best Dosage of Guanfacine to Treat ADHD Symptoms?

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.

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).

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. 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.

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.

What are the Side Effects of Guanfacine?

Most people taking guanfacine do not experience side effects. That said, the most common guanfacine side effects are:

  • sedation
  • tiredness
  • difficulty sleeping
  • low blood pressure
  • nausea
  • stomach pain
  • dizziness
  • dry mouth
  • irritability
  • vomiting
  • slow heart rate

Serious side effects of guanfacine also 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.

Guanfacine and Heart or Blood Pressure Related Problems


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?

  • 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.

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. .

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:

Guanfacine- guanfacine hydrochloride tablet. Daily Med (2017). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6fdcebac-0a5a-4858-b0e6-87f77ba53bf1

Guanfacine tablet- extended release. Daily Med (2019). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=301f01a7-2b0a-cfba-9c3d-a1dd831785a3

Newcorn, Jeffrey, et al. Extended‐release guanfacine hydrochloride in 6–17‐year olds with ADHD: a randomised‐withdrawal maintenance of efficacy study. The Association for Child and Adolescent Mental Health (2016). https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.12492

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?

 

15 Guanfacine: ADHD Medication 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.

  11. My comment to anyone with child is too and I mean demand an MRI of the brain. I have been through all of what I have read this far in the comments made. I asked for four years for that my son to recieve an MRI. I was declined on each attempt tried. Medications being several, were not the way. Years later after I finally demanded one. The results were a tumor pressing on certain parts of his brain. It was night and day. The hyper-activity the so called ADHD, ended. Please please please demand one it may not even be that your child have a tumor of his or her brain, but I have at least put or if you have had thought or if even those of you who have already suggested to their doctor; I am strongly suggesting that you persue it full fledged and do not take NO or not enough probable cause because the doctor is not the boss you are so take that roll and stand over it and protect. Amen Jesus loves us all. Read your bible it tells us so.

  12. just read the comment about the MRI. My MIL as been trying to get us to do one! even if we pay out of pocket! i have been calling and calling! thank you for that comment. I do think it is something every parent should do. I don’t understand why our children have to try a million medicines without having any more medical testing! its quite sad they want to give our kids these medicines with a million side effects and try so many but will not give an MRI!!!!

  13. Hi everyone, can anyone help me? I have a 7 year old son who has ADAD,and Autism. Me and my wife are against giving him meds but his behavior is getting worse. His doctor just prescribed Guanfacine, half tab in the morning and half a night. I would like a perspective and advise from anyone here since you all went thru what I’m currently going thru.

    My other problem is he stays from morning until night rocking back and fourth watching youtube of kids playing vedio game. I can’t get him off of it without going bizzerk. How do I fix that issuie.

    I will request a MRI on his brain.

    Thank You All
    God Bless

    Youseph

  14. This is in response to Youseph’s questions, in case he happens to see it. I have a 10yro with autism and ADHD. He’s higher functioning and severely ADHD. I struggled with the decision to medicate him, but when we put him on one medication, his attention went from 35% to 95%. We’ve since realized he has tourette’s, though, so we’re in the middle of changing his medication to reduce the tics he has from it. I highly recommend at least trying medications. If they work, they’re amazing. If they don’t work, well, at least you tried.

    Regarding your son going crazy after watching videos all day long, that’s actually very normal for most kids–especially ones with autism or ADHD. They don’t like being interrupted, and they have lots of pent up energy from staring at the screen all day instead of being active, learning and doing things with their bodies. If your child is higher functioning, don’t give him the device at all and get him active doing other things, like learning how to care for himself and the house, the yard, going to parks, into nature, etc. If you want him using a device to give you a break, limit his use to 25-30min periods of time. Make sure he knows first that this change will be happening and that if he stays calm when his time is over, he’ll get to use it again in a certain amount of time. Expect the change to take a while if he’s really been spending days staring at a screen. Give him useful, enjoyable things to do. If he rocks often, give him a rocking chair or a swing to swing in.

    If he’s lower functioning, you’ll need more professional support to get him off the device, like occupational therapy, behavioral therapy, and sensory processing integration therapy (often included with OT but not always) to help him develop basic, everyday skills. If he’s low functioning, he should be receiving several hours of therapy each week if not each day. Even higher functioning children often need weekly therapy sessions. Ask his doctor for a referral if needed. It’s essential that kids are busy learning as much as we can help them learn about how to care for themselves, interact well with their family and community, and learn to help out with every day tasks. Even a child who isn’t talking at 4 may end up talking by 7. You just never know what a child can accomplish until you work with them the right way and for long enough.

    God Bless,
    Rebecca

  15. P.S. Reading about autism and Montessori may help you in your journey with your son. Doing so has certainly helped me–with all five of my children!

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