Guanfacine: Non-Stimulant Medication for ADHD
Guanfacine HCL is a non-stimulant medication used to treat symptoms of ADHD. It is typically used alone but sometimes prescribed with a stimulant as a complementary treatment therapy.
Brand Name: Intuniv, Tenex
What Is Guanfacine?
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 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 ADHD 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.
Guanfacine Side Effects
The most common guanfacine side effects are:
- difficulty sleeping
- low blood pressure
- stomach pain
- dry mouth
- 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.
More Information on Guanfacine and Other ADHD Medications:
Tips for Good Medication and Treatment Reviews
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