Guanfacine ER
INTUNIV
What it isGuanfacine ER (INTUNIV, 2009) is a selective alpha-2A agonist for nonstimulant ADHD treatment; approved ages: 6-17.
Why this oneDuration of action 24 h (Carlat Table 1); greater alpha-2A selectivity makes it less sedating and hypotensive than clonidine.
What limits itER is NOT 1:1 with IR; no high-fat meals. Sedation, bradycardia and hypotension limit use; taper rather than stopping abruptly to prevent rebound hypertension.
FDA-approved for
- ADHD (2009)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| ADHD (monotherapy or adjunct to stimulants) | Children/adolescents 6-17 yr | 1 mg QD | 0.05-0.12 mg/kg/day (1-7 mg) | 4 mg/day (ages 6-12); 7 mg/day (ages 13-17) |
Titration Adjust in increments of no more than 1 mg/week
Renal May need dosage reduction in significant renal impairment
Hepatic May need dosage reduction in significant hepatic impairment
Halve dose with strong/moderate CYP3A4 inhibitors; consider doubling with CYP3A4 inducers
Instructions
- Swallow tablets whole; do not crush, chew, or break
- Do not administer with high-fat meals
- Do not substitute for immediate-release guanfacine on a mg-per-mg basis
- When discontinuing, taper by no more than 1 mg every 3-7 days to avoid rebound hypertension
Contraindications
- History of hypersensitivity reaction to guanfacine extended-release tablets, their inactive ingredients, or other products containing guanfacine
Cautions
- Hypotension, bradycardia, syncope — titrate slowly, monitor vitals
- Sedation and somnolence
- Cardiac conduction abnormalities (may worsen sinus node dysfunction/AV block)
- Rebound hypertension on abrupt discontinuation
Adverse reactions
- Somnolence
- Fatigue
- Hypotension
- Dizziness
- Lethargy
- Nausea
- Dry mouth
- Abdominal pain
- Irritability
- Bradycardia
Pregnancy Available data over decades have not identified a drug-associated risk; use in pregnancy has been infrequent
Lactation No data on presence in human milk; monitor breastfed infant for hypotension/bradycardia (sedation, lethargy, poor feeding)
NO BOXED WARNINGS
Principal riskSedation and hypotension; rebound on abrupt withdrawal
Classes and tags
Clinical profile
Mechanism of action: Guanfacine ER ballicule
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Memory aids: mascots and interaction avatars
Orange plus signs → α2 agonist
