Intuniv (Guanfacine) - Oral

What Is Intuniv?

Intuniv (guanfacine) is a prescription non-stimulant treatment for attention-deficit/hyperactivity disorder (ADHD). It can be used as a monotherapy (single treatment) or as an add-on (adjunctive) treatment to stimulant medications. It can also be used to treat hypertension (high blood pressure).

Intuniv is a central alpha-2A adrenergic receptor agonist. It works on receptors in the prefrontal cortex (PFC) in the brain to enhance functioning. The PFC plays a role in cognitive behavior, including attention and impulsivity.

Intuniv is available as an extended-release tablet to be taken by mouth.

Drug Facts

Generic Name: Guanfacine

Brand Name(s): Intuniv, Tenex

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Antihypertensive

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Guanfacine hydrochloride

Dosage Form(s): Extended-release tablet

What Is Intuniv Used For?

The Food and Drug Administration (FDA) approved Intuniv to treat ADHD as either a monotherapy or adjunctive therapy to stimulant medications. It helps to improve common symptoms associated with ADHD, such as concentration difficulties, distractedness, and impulsiveness.

Intuniv may sometimes be prescribed with another type of ADHD medication known as a stimulant. Stimulants are typically used as first-line treatment for people with ADHD.

In some cases, nonstimulants may be the preferred choice of treatment if you have:

Often, ADHD medications like Intuniv are used in concert with behavioral therapy. For children with ADHD, behavioral management training for the parents is also involved.

Guanfacine is also used to treat high blood pressure. As a blood-pressure-lowering agent, it works to decrease heart rate and relax the blood vessels to allow blood to flow through them more easily. This helps lower blood pressure.

How to Take Intuniv

The following are recommendations for using Intuniv; however, always take it as ordered by your healthcare provider. These recommendations include:

  • Take it once a day at the same time, either morning or evening. You may want to take it in the evening if you experience side effects of fatigue and drowsiness.
  • Do not take with a high-fat meal, as this can increase exposure to guanfacine. Instead, take it with a light meal or without food.
  • Swallow the extended-release tablets whole with a small amount of water or another liquid; do not break, chew, or crush them.
  • Do not take this medication with grapefruit or grapefruit juice.

Storage

Follow these guidelines for storage:

  • Dispose of unused medication through a pharmacy or a medication disposal company.
  • Do not open the medication bottle until ready to give the first dose. 
  • Keep away from children.
  • Keep away from moisture (e.g., avoid storing it in the bathroom)
  • Once expired, dispose of medication.
  • Protect from light, extreme heat, and extreme cold
  • Store in the original airtight container

Off-Label Uses

Intuniv can be prescribed off-label (for a non-FDA approved use) for:

How Long Does Intuniv Take to Work?

It can take several weeks to get the maximum benefit of Intuniv, although you may notice an improvement in some symptoms sooner. In clinical trials, children and adolescents taking extended-release Intuniv showed symptom improvement starting one to two weeks after initiating treatment. In addition, an open-label, long-term, phase 3 study involving adults demonstrated significant symptom improvement with extended-release Intuniv therapy within the first six weeks.

What Are the Side Effects of Intuniv?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

As with all medications, side effects can occur while taking Intuniv. Common and less severe side effects include:

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include the following:

  • Psychiatric reactions, such as agitation, anxiety, and depression
  • Asthenia (abnormal weakness)
  • Asthma
  • Atrioventricular (AV) block, also called a heart block (a condition in which the heart's electrical signal slows or stops completely due to blockage)
  • Convulsion
  • Dyspepsia (indigestion)
  • Hypertension
  • Sinus arrhythmia, or when your heartbeat is too fast, too slow, or irregular

Report Side Effects

Intuniv may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Intuniv Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release tablets):
    • For attention deficit hyperactivity disorder (ADHD):
      • Adults and children 6 years of age and older—At first, 1 milligram (mg) once a day, either in the morning or evening, at the same time each day. Your doctor may slowly adjust your dose as needed and tolerated. However, the dose is usually not more than 4 mg per day.
      • Children younger than 6 years of age—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • For high blood pressure:
      • Adults—At first, 1 milligram (mg) once a day, at bedtime. Your doctor may slowly increase your dose up to 3 mg per day, as needed.
      • Children—Use and dose must be determined by your doctor.

Modifications

Due to the possible effects of this medication, there may be changes to how it is used. The following circumstances may necessitate a dosage adjustment or extra caution when taking Intuniv:

  • Severe kidney disease: As kidney function decreases, it becomes more difficult for the body to eliminate guanfacine from the body. Depending on your level of kidney function, you may need a dose adjustment with Intuniv.
  • Severe liver disease: Guanfacine is cleared from the body through the kidneys and liver. Significant liver impairment may require a different dose of Intuniv.
  • Breastfeeding: It is unknown whether guanfacine passes into human breast milk. Use caution while taking Intuniv if you are breastfeeding or plan to breastfeed, and watch for signs of sedation in breastfed infants. Consult your healthcare provider before breastfeeding.

Missed Dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Call your healthcare provider if you miss two or more consecutive doses of the extended-release tablets.

Overdose: What Happens If I Take Too Much Intuniv?

Inform your healthcare provider immediately if you take too much Intuniv. Symptoms of an overdose may include:

  • Blurred vision
  • Constricted pupils
  • Dizziness
  • Drowsiness
  • Fainting
  • Lack of energy
  • Slow heart rate

What Happens If I Overdose on Intuniv?

If you think you or someone else may have overdosed on Intuniv, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Intuniv, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

Your doctor should check you or your child's progress at regular visits to make sure this medicine is working properly and to decide if you or your child should continue to take it.

You or your child will also need to have your blood pressure and heart rate measured before starting this medicine and while you or your child are using it. If you notice any change to you or your child's recommended blood pressure or heart rate, call your doctor right away. If you have questions about this, talk to your doctor.

Do not suddenly stop taking this medicine without checking first with your doctor. Stopping this medicine suddenly may increase your blood pressure and heart rate (rebound hypertension). Your doctor may want you to slowly reduce the amount you or your child are taking before stopping it completely.

Make sure that you have enough guanfacine on hand to last through the weekends, holidays, and vacations. You should not miss any doses. You may want to ask your doctor for another written prescription for guanfacine to carry in your wallet or purse. You can then have it filled if you run out when you are away from home.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine.

Guanfacine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you or your child are using this medicine.

Guanfacine may cause some people to become dizzy, drowsy, faint, lightheaded, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Also, standing up slowly when getting up from a lying or sitting position may also help.

This medicine may worsen heart rhythm problems (eg, sinus node dysfunction, atrioventricular block), especially in patients who are taking other medicines. Talk to your doctor if you have concerns.

Guanfacine may cause dryness of the mouth, nose, and throat. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your physician or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Intuniv?

There are a few reasons why you might not be able to take Intuniv, including:

  • Pregnancy: There is limited data on whether this medication crosses the placenta. Talk to your healthcare provider if you plan to become pregnant or become pregnant while on this medication to discuss the next steps for your treatment.
  • Breastfeeding: Guanfacine has not been studied in breastfeeding for humans. You may wish to change your medication plan if you are concerned about adverse effects in your breastfeeding infant. Talk to your healthcare provider to determine the best plan for you and your baby.
  • Allergy: You should not take Intuniv if you have a history of hypersensitivity to guanfacine or its other ingredients.

What Other Medications Interact With Intuniv?

Other medications can interact with Intuniv. In some cases, you can still use these medications together. Ultimately, your healthcare provider may need to change the drug's doses or monitor for potential side effects.

Watch for potential central nervous system (CNS) side effects when taking Intuniv with valproic acid. Taking these medications together can increase concentrations of valproic acid. Additionally, taking guanfacine with other antihypertensive drugs can cause side effects such as hypotension (low blood pressure) and syncope (fainting) due to the additive blood-pressure-lowering effects.

Monitor for increased somnolence or sedation when taking Intuniv with the following:

Examples of other medications that interact with Intuniv are:

This is not a complete list of drug interactions that can occur with Intuniv. Be sure to always tell your healthcare provider about your current use of prescription and over-the-counter medications, supplements, and herbal supplements. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Ask your healthcare provider or pharmacist for a comprehensive list of potential drug interactions.

What Medications Are Similar?

Intuniv is a nonstimulant medication used to treat ADHD. It belongs to a class of medications called alpha-2 adrenergic agonists. The only other ADHD drug in this class is Kapvay (clonidine).

Like Intuniv, clonidine is an extended-release medication used to improve ADHD symptoms. Clonidine can be used as a monotherapy or in addition to stimulant therapy.

Guanfacine and clonidine are pharmacologically similar, sharing the same mechanism of action. However, guanfacine is approximately 10 times less potent than clonidine and is metabolized differently. Still, adverse effects are generally similar between the two medications.

Frequently Asked Questions

  • What is Intuniv used for?

    Intuniv is used to treat symptoms of attention-deficit/hyperactivity disorder (ADHD). It can be used as a monotherapy or in addition to treatment with stimulant medications. Guanfacine is also used to treat high blood pressure.

  • What are the side effects of Intuniv?

    The most common side effects of Intuniv include dry mouth, tiredness, weakness, drowsiness, headache, irritability, and stomach pain. Many of these side effects are dose-related and range from mild to moderate in severity. Often, they will be temporary. However, contact your healthcare provider if side effects persist or worsen, as you may need a dose adjustment.

  • How does Intuniv work?

    Intuniv is a central alpha-2A adrenergic receptor agonist that improves ADHD symptoms such as emotional sensitivity, hyperarousal, rejection sensitivity, and social aggression that are not addressed by stimulant medications. In addition, it affects receptors in the brain's prefrontal cortex, which plays a role in cognitive functioning, such as attention and impulsivity.

  • Are there any foods that should be avoided while taking Intuniv?

    While taking Intuniv, avoid meals with a high-fat content and grapefruit-containing products (e.g., grapefruit juice). Instead, take it with a light meal or without food. Reach out to your healthcare provider or consult a registered dietitian and nutritionist (RDN) if you're unsure which foods are high in fat. They can help you adjust your eating plan.

  • How is Intuniv administered?

    Intuniv is administered as an extended-release oral tablet. Extended release means the medication is long-acting. Take it as prescribed, usually once a day, and at the same time each day.

How Can I Stay Healthy While Taking Intuniv?

Intuniv is a once-a-day non-stimulant medication used to treat ADHD in adults and children between the ages of 6 and 17. This medication can be used either alone or in conjunction with stimulant ADHD medications such as Concerta (methylphenidate), Focalin (dexmethylphenidate), Adderall XR (amphetamine and dextroamphetamine), or Vyvanse (lisdexamfetamine).

Often, nonstimulant therapy is just one part of a multi-pronged approach to managing ADHD symptoms. Treatment is often individualized, as there is no one-size-fits-all approach. Other medications or different types of therapy, such as behavior therapy or psychotherapy, may also be part of your treatment plan.

If multiple medications are part of your treatment, it may be challenging to remember when to take each dose. Because Intuniv is an extended-release formulation, it only needs to be taken once daily. However, other medications may need to be taken several times daily. Try using a pillbox or medication app reminder to keep track of your dosing schedule.

Before starting any new medications or using complementary treatments, ask your healthcare provider or pharmacist about the potential interaction risks. Remember that it might take time to adjust to your treatment regimen and could take several weeks before noticing any improvement. Don't hesitate to communicate how you feel to your healthcare team; they can help manage side effects or switch to a different therapy if needed.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Kathleen Gaines, MSN, RN, CBC
Kathleen Gaines, MSN, RN, CBC, is a nurse and health journalist, as well as an adjunct clinical faculty member at hospitals in the Philadelphia area.