guanfacine ER

Adjunctive therapy

Brands: INTUNIV

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is guanfacine ER?
Guanfacine extended-release (brand Intuniv) is a non-stimulant ADHD medication and an alpha-2A adrenergic agonist. It is often used when stimulants are poorly tolerated, when tics/anxiety/insomnia complicate stimulant use, or as an adjunct to stimulants for residual impulsivity.
What is INTUNIV?
INTUNIV is a brand name for guanfacine ER.
What is INTUNIV (guanfacine ER) used for?
Label indications include: Attention-deficit/hyperactivity disorder (ADHD) (extended-release formulation; product-dependent).
What drug class is INTUNIV (guanfacine ER)?
Alpha-2A adrenergic agonist (non-stimulant ADHD medication).
What strengths does INTUNIV (guanfacine ER) come in?
Extended-release oral tablets (once-daily).

Snapshot

Class: Adjunctive therapy
Common US brands: INTUNIV
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Attention-deficit/hyperactivity disorder (ADHD) (extended-release formulation; product-dependent).

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Clinical Highlights

Guanfacine extended-release (brand Intuniv) is a non-stimulant ADHD medication and an alpha-2A adrenergic agonist. It is often used when stimulants are poorly tolerated, when tics/anxiety/insomnia complicate stimulant use, or as an adjunct to stimulants for residual impulsivity. Compared with clonidine ER, guanfacine ER is generally less sedating and more selective for alpha-2A receptors, but daytime sleepiness and dizziness can still be clinically limiting early in treatment.

It tends to help hyperactivity, impulsivity, and emotional reactivity more than isolated inattention. It is often considered when restlessness, evening rebound, tics, or sleep-onset problems complicate stimulant regimens, or when a non-controlled option is preferred.
In serious mental illness, guanfacine ER may be attractive when stimulant activation or diversion risk is high, but hypotension, bradycardia, and additive sedation with other CNS depressants remain important monitoring targets.
The compare view, the guanfacine ER evidence feed, and the guanfacine ER print page support side-by-side review and patient-friendly handouts for titration and tapering.

Dosing & Formulations

Typically dosed once daily; morning dosing is common, but bedtime dosing can help when sedation is prominent. Dosing typically starts low and titrates weekly as tolerated. Typical doses are 1–4 mg/day (product- and age-dependent).

Expect gradual improvement over days to weeks. If sedation or dizziness emerges, slower titration and dose-timing adjustments are common first steps before concluding the medication is ineffective.
Abrupt discontinuation can lead to rebound hypertension, tachycardia, and agitation; a taper is typically used to reduce this risk.
If sedation limits daytime functioning, slower titration and evening dosing are common adjustments; interacting sedating medications can also contribute.

Monitoring & Risks

Blood pressure and heart rate: commonly checked at baseline and during titration; counseling often covers dizziness and orthostasis. Sedation: common early; combining with other sedatives can increase impairment, and driving/occupational risks are often revisited.

Rebound: abrupt discontinuation can cause rebound hypertension and irritability; taper planning in advance can reduce this risk.
Safety: falls/syncope risk is often revisited when dizziness is prominent, along with driving and occupational safety during initiation and dose changes.

Drug Interactions

CYP3A4 inhibitors can increase exposure and worsen hypotension/sedation; inducers may reduce efficacy. Additive hypotension or sedation can occur with other antihypertensives or CNS depressants.

Practice Notes

Guanfacine ER is often used as an adjunct when stimulants improve focus but residual impulsivity, irritability, or sleep problems persist. When daytime fatigue dominates, bedtime dosing may help; if impairment persists, alternative non-stimulants are often considered rather than adding stimulants back solely to counter sedation.

Because rebound symptoms can occur with abrupt discontinuation, a taper plan is often documented early to support future care transitions.
When adding guanfacine ER to a stimulant regimen, clinicians often revisit whether the stimulant dose can be lowered once symptoms are stable (often improving appetite, anxiety, and sleep).

References

Intuniv (guanfacine Extended Release) Prescribing Information — DailyMed (2025)
Attention deficit hyperactivity disorder (NICE guideline NG87) — NICE (2018)
Clinical Practice Guideline FOR THE Diagnosis, Evaluation, AND Treatment OF Attention Deficit/hyperactivity Disorder IN Children AND Adolescents — Pediatrics (2019)
Comparative Efficacy AND Tolerability OF Medications FOR Adhd (systematic Review AND Network Meta Analysis) — Lancet Psychiatry (2018)