Guanfacine is a nonstimulant medication that may help support impulse control and attention span in people with ADHD, particularly children 12 and younger.

Guanfacine belongs to the class of medications known as central alpha 2A-adrenergic receptor agonists.

This class of medications generally helps open your blood vessels, which may lower your heart rate and blood pressure.

Researchers have found that guanfacine may help improve the function of the prefrontal cortex, which is the part of your brain that regulates attention and impulse control. For this reason, doctors may prescribe it to treat attention deficit hyperactivity disorder (ADHD).

For some people with ADHD, stimulant medications aren’t always the best choice, and they may look for an alternative.

A doctor might consider using a nonstimulant medication like guanfacine for ADHD:

  • children between 6 and 17 years old
  • stimulants aren’t working well in managing ADHD symptoms
  • stimulants cause too many side effects
  • a child or teen has a substance use disorder
  • a child or teenager has a medical condition for which stimulants should not be used

About this medication

The Food and Drug Administration (FDA) approved an extended-release version of guanfacine to treat attention deficit hyperactivity disorder (ADHD) in children and teenagers ages 6 to 17 years old. For adults, doctors may prescribe it off-label.

Key facts about guanfacine include:

  • It’s more commonly used to treat hypertension and to help prevent serious health conditions, such as heart attack and stroke, in people with higher-than-normal blood pressure.
  • It was previously sold in the United States under the brand name Tenex and is currently still available as a generic guanfacine immediate release (IR). When sold under the name Intuniv, it’s used to treat ADHD. While the generic version and Intuniv contain guanfacine, the recommended dosage differs.
  • Guanfacine is typically only used for ADHD when stimulants like amphetamine-dextroamphetamine (Adderall) are not suitable, not tolerated, or not effective. The medication appears to be most effective in children 12 years old or younger.
  • Intuniv is an extended-release (ER) formulation of guanfacine that may be given in addition to stimulants or as part of a treatment program that also includes psychological counseling and educational measures. Research shows the medication could also be as effective in treating ADHD in adults.

Treatment approaches that combine behavioral therapy and medication have shown to be the most effective compared with using either treatment alone. The recommendations may vary depending on the person’s age.

Guanfacine ER or Intuniv should be taken as a tablet by mouth. The tablets should not be crushed, chewed, or broken before swallowing.

For Intuniv, your child can often be given a 1-milligram (mg) dose once daily. However, doctors will often begin with the smallest, most effective dose, taking various criteria into consideration.

The typical dosage of guanfacine IR for ADHD is 0.5 mg to 1 mg between one and four times daily. It’s important that you speak with your child’s doctor if you want to stop the medication, as discontinuing may require slow tapering to avoid a rise in blood pressure.

The dose may be slowly increased over the next 4 to 7 weeks based on the child’s age and weight. During this time, your child will be monitored for any side effects.

The maximum dosage is between 5 mg and 7 mg per day, depending on the child’s weight and age.

It’s important to note that guanfacine IR and Intuniv cannot be substituted for each other on a mg-per-mg basis. While both drugs contain guanfacine, there are differences in how the pills are formulated.

Extended-release medications like Intuniv are released slowly into the body over time. Guanfacine IR is an immediate-release drug that releases the medication into the body right away.

Your child’s heart rate and blood pressure will be measured before treatment begins and periodically during the treatment period.

There are some risks with taking guanfacine. The first is potential side effects, and the second is drug interactions.

The most commonly reported side effects of guanfacine include:

Serious side effects may include:

  • lower-than-normal blood pressure (hypotension)
  • increased blood pressure if the medication is stopped suddenly (hypertension)
  • weight gain
  • fainting
  • slower heart rate
  • trouble breathing, which can quickly become a medical emergency
Warning

Guanfacine can also interact with other medications, including herbal supplements and over-the-counter medications. Taking guanfacine with any of the following drugs or classes of medications may require adjustments to dosage:

  • CYP3A4/5 inhibitors, such as ketoconazole, which includes grapefruit and grapefruit juice
  • CYP3A4 inducers, such as rifampin (Rifadin), which is an antibiotic
  • valproic acid (Depakene), an anticonvulsant medication
  • medications used to treat hypertension (antihypertensive drugs)
  • central nervous system depressants, including alcohol, benzodiazepines, opioids, and antipsychotics

Use caution if you have a history of fainting, heart disease, low blood pressure, depression, or heart block. This medication may complicate your condition or make its symptoms worse.

The most commonly used medications for ADHD are in a class of compounds known as stimulants. These work by increasing dopamine and norepinephrine in the brain. They include:

  • methylphenidate (Ritalin, Concerta)
  • amphetamine-dextroamphetamine (Adderall)
  • dextroamphetamine (Dexedrine)
  • lisdexamfetamine (Vyvanse)

However, some people with ADHD cannot tolerate stimulants. In these cases, a doctor may prescribe nonstimulant medications like guanfacine. Taking these will not increase your dopamine levels, but this means it can take longer to see results. These medications are also less addictive.

Other than guanfacine, which is approved for children and adolescents, there are two nonstimulant drugs FDA approved to treat ADHD in adults:

Other ADHD medications

Find out more about other ADHD medications that you might discuss with your doctor and healthcare team.

You can also learn more about determining if your current ADHD medication works and what you may discuss with your healthcare team about possible care plan changes.

Both Guanfacine IR and Intuniv contain guanfacine and may be used to treat ADHD in children, but only Intuniv is FDA approved for this purpose.

Though both Guanfacine IR and Intuniv contain guanfacine, their formulations differ, so be sure to talk with your doctor about your child’s dosage and treatment.