What is Guanfacine?

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder, but it also affects many adults in the United States. You can find out more about ADHD in the NIMH ADHD treatment overview.

There are both stimulant and non-stimulant ADHD medications available, and one non-stimulant option is guanfacine. Guanfacine is an ADHD medication classified as an Alpha-2 adrenergic agonist, which was originally created to help reduce blood pressure issues. It works in the cardiovascular system by relaxing blood vessels, but it was later discovered to affect the prefrontal cortex of the brain, which regulates behavior and executive functioning.

Guanfacine is used for ADHD under the brand name Intuniv. Intuniv is an extended-release version of the drug. It is FDA-approved for use in children and adolescents ages 6-17. It is not FDA-approved for adult use, though medical professionals do prescribe it as an off-label non-stimulant option for adults with ADHD. Guanfacine is not a stimulant drug and is not a controlled substance.

At ADHD Advisor, we provide comprehensive care for adults who are 18 years of age or older. Our team of professionals may prescribe guanfacine for adults with ADHD if it is deemed a necessary part of their treatment plan, ensuring that you are appropriately supported throughout your journey to manage ADHD.

How Guanfacine Works

Guanfacine works on both the central nervous system and the cardiovascular system. It is classified as an alpha-2A adrenergic receptor agonist. It stimulates the alpha-2 receptors in the brain found primarily in the prefrontal cortex. The prefrontal cortex is an area of the brain that controls impulses, memory, and attention. 

By stimulating the alpha-2 receptors in this region, guanfacine can assist the neurotransmitters, mainly norepinephrine, that control these functions. By regulating norepinephrine, guanfacine decreases ADHD symptoms such as hyperactivity and impulsivity and helps maintain regular sleep.

Guanfacine's mechanism of action is different from stimulants and SNRIs. Stimulants and SNRIs target the neurotransmitter norepinephrine directly, whereas Guanfacine targets the alpha-2 receptors, affecting norepinephrine indirectly.

Who Can Take Guanfacine

Intuniv (guanfacine extended-release tablets) is FDA-approved to treat ADHD in children and adolescents ages 6 to 17. It is sometimes prescribed off-label to adults with ADHD. The immediate-release version, Tenex, is also prescribed as an off-label treatment for adults with ADHD. It can also sometimes be prescribed off-label for people with post-traumatic stress disorder (PTSD), tics, anxiety, and sleep or impulsivity issues.

Contraindications

Some people with pre-existing conditions may not be well-suited to take guanfacine ADHD medication. The following groups of people could have negative interactions if taking this medication:

• Individuals with renal or liver disease
• Individuals with hypotension (low blood pressure)
• Individuals who are hypersensitive to any of the ingredients in Intuniv
• Individuals with heart block

It's important to note that ADHD Advisor only works with adults 18 years of age or older. Only a licensed healthcare provider can determine if this medication is appropriate for you.

If appropriate, doctors will monitor blood pressure and heart rate before starting guanfacine and throughout to ensure it's safe to continue taking this medication.

Dosages and Administration

Let’s look at the guanfacine dosage for ADHD. 

Intuniv for ADHD is started for children 6 years and older at 1 milligram once daily, often at bedtime, as it can cause some drowsiness. Dosage may be slowly titrated to 1-4 milligrams a day, depending on tolerability and response to the medication.

Guanfacine for adults is off-label but typically starts at 1 milligram daily. IR guanfacine or Temex, which is sometimes used off-label for adults with ADHD, can be given at various doses. As guanfacine can lower blood pressure, it is important to taper gradually off this medication if stopping, to avoid rebound hypertension.

It's important to note that while these are common dosage limits, only a medical doctor can determine safe dosing levels for each individual.

Side Effects and Risks

Let’s go over some of the guanfacine side effects and possible risks.

Side Effects

As with any medication, there are some potential side effects to consider. Possible common side effects may include: (MedlinePlus: guanfacine)

• Dizziness
• Drowsiness
• Dry mouth
• Irritability
• Fatigue
• Stomach pain, constipation, and nausea
• Headache
• Sweating

Serious side effects can include:

• Slow heart rate
• Low blood pressure
• Fainting
• Rebounding hypertension
• Allergic reactions: hives, swollen mouth or lips, difficulty breathing

For more information about potential side effects, check with DailyMed: guanfacine.

It's important to be aware of potential side effects and discuss them with your healthcare provider. If you happen to experience any adverse side effects, you can report them to the FDA MedWatch's reporting program.

Risks

Certain groups of people should not take guanfacine, or Intuniv, for ADHD. It's important to discuss with your doctor if you have low blood pressure, a heart block, kidney or liver conditions, or any other health issue to ensure there are no risks when taking this medication.

The most serious risks associated with guanfacine stem from its cardiovascular effects and potential to lower blood pressure, according to the AHA on guanfacine for blood pressure. There are some drug interactions to be aware of, so always let your doctor know what medications you are currently taking, including supplements and vitamins, before starting guanfacine.

It's important to note that guanfacine is not addictive, nor is it a controlled substance, according to the DEA controlled substance schedules. This reassures you that you can use this medication as part of your treatment plan without the potential risks of misuse.

Guanfacine vs. Other ADHD Medications

Let's go over how guanfacine compares with other ADHD medications.

Guanfacine vs Clonidine

Guanfacine and clonidine are both classified as alpha-2-adrenergic agonists. They have a similar mechanism of action and can be used to help reduce ADHD symptoms. The big difference when comparing guanfacine vs clonidine is that guanfacine is often less sedating than clonidine and has a longer half-life. Some studies have found that guanfacine was more effective at improving planning and working memory.

Guanfacine vs Stimulants

Guanfacine and stimulants work very differently on the brain to help reduce ADHD symptoms. Stimulants increase the levels of dopamine in the brain, which helps people focus and concentrate better. Guanfacine may be less effective for those symptoms than stimulants, but can be helpful for hyperactivity and sleep issues. Stimulants are often the first line of defense for ADHD; however, non-stimulant options are good for those for whom stimulants are not a good option or contraindicated.

Guanfacine vs Atomoxetine or Viloxazine

Guanfacine and atomoxetine (Straterra) or viloxazine (Qulbree) are all non-stimulant ADHD medication options, but with different mechanisms of action.  Atomoxetine and viloxazine are selective norepinephrine reuptake inhibitors (SNRIs). SNRIs work by increasing the levels of norepinephrine in the brain, which helps to improve attention and focus issues with ADHD. Guanfacine helps to improve attention, too, but through the alpha-2 receptors.

Both atomoxetine and viloxazine are often used as adjuncts with other drugs such as stimulants.

ADHD Care with ADHD Advisor: Nationwide Non-Stimulant Access

ADHD can be successfully treated with therapy, stimulant, and non-stimulant medications, according to the CDC ADHD treatment guidance.

One non-stimulant option could be guanfacine. With ADHD Advisor, you can potentially receive a guanfacine prescription for ADHD if healthcare professionals determine that it's necessary. We offer nationwide guanfacine prescriptions for adults 18 years of age or older. We also provide other non-stimulant options for individuals with ADHD nationwide.

We do offer stimulant prescriptions for ADHD, but only in select states. So, for example, you may qualify for stimulants via an online ADHD doctor in Florida. Similarly, online Adderall in Texas may be available to those who receive a prescription as part of their treatment plan.

ADHD Advisor can also help you with prescription fulfillment if necessary, and we can have the prescriptions sent to your pharmacy of choice. We also offer a superbill that you can give to your insurance company for potential reimbursement, depending on your plan. Now, let's take a look at how to get diagnosed with ADHD online with ADHD Advisor.

Step-by-Step Process

Learn how to get tested for ADHD online by using our simple step-by-step process.

1. First, you’ll take our initial assessment to determine if you need a diagnosis appointment.
2. Schedule your telehealth evaluation with a healthcare provider to go over your assessment and potential treatment plan.
3. Receive your unique treatment plan, which can include therapy and ADHD medication online, both non-stimulant and stimulant medication if eligible, and in specific states where we prescribe stimulants.
4. Guanfacine is available through ADHD Advisor nationwide for adults 18 and up if deemed necessary.
5. Receive ongoing follow-up appointments to continue to monitor symptoms and blood pressure regulation.

Access, Cost & Insurance

Once you have a prescription for guanfacine, you can find it at most U.S. pharmacies nationwide. The cost varies. Without insurance, brand-name Intuniv can cost around $350, and a generic is often cheaper. Of course, the price depends on your dose, insurance, and the pharmacy that you choose.

It's important to note that ADHD Advisor does not bill insurance. We offer a superbill that you can send to your insurance company for potential reimbursement.

FAQs

Is guanfacine FDA-approved for ADHD?

Yes, the extended-release guanfacine (Intuniv) is FDA-approved for children and adolescents with ADHD aged 6 to 17. It can be prescribed for adults as an "off-label" nonstimulant option for ADHD.

Can ADHD Advisor prescribe guanfacine?

Yes, ADHD Advisor can prescribe guanfacine nationwide for adults 18 and older, if healthcare professionals determine that guanfacine is a necessary part of your treatment plan.

Is guanfacine addictive?

No, guanfacine is not a controlled substance, so it isn't addictive. However, if you are taking this medication, it's important to taper off if you stop taking it to reduce the risk of rebounding high blood pressure.

How does guanfacine compare to clonidine?

Guanfacine and clonidine are both alpha-2 agonists that have been clinically proven to treat ADHD symptoms. They can both be used as monotherapy or an adjunct treatment option. Guanfacine is similar in mechanism of action to clonidine but tends to be less sedating and longer-acting than clonidine.

What are common side effects?

While medications have many potential benefits, they may still cause side effects. Some significant side effects to be aware of with guanfacine include:

• Sleepiness
• Dizziness
• Dry mouth
• Headaches
• Stomach issues
• Sweating