Guanfacine For ADHD: Side Effects, Dosage, And More

Finding the right medication for attention deficit hyperactivity disorder (ADHD) can make a world of difference in a child's life. In some instances, it can take trial and error to discover what treatment works best. If you're comparing ADHD medications or your child's doctor has recently recommended Guanfacine for ADHD symptoms, it makes sense to want more information.

So, what should you know about Guanfacine for the treatment of ADHD? In this article, we'll talk about Guanfacine and its use, whether Guanfacine is effective for ADHD, and how the medication is used to address ADHD symptoms specifically. Then, we'll go over side effects, dosing, and potential risks.

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What Is Guanfacine?

Guanfacine hydrochloride is a non-stimulant prescription medication that can be used to treat ADHD and other medical problems. Guanfacine hydrochloride is also prescribed under the names Tenex and Intuitiv. It is part of a medication class called alpha-2 adrenergic agonists. 

Not everyone reacts to stimulant medications the same way. Though stimulants are often the first medications used to treat ADHD and are effective for many people with the condition, it is important that other options, such as Guanfacine, are available.

Like other medicines used for treating ADHD, Guanfacine can be prescribed by a number of different professionals. These include but aren't limited to primary care physicians and psychiatrists.

Uses

Guanfacine can be prescribed for more than one medical condition. The most common uses of Guanfacine include ADHD and high blood pressure.

ADHD symptoms

Guanfacine extended-release tablets are approved for treating ADHD in children and adolescents between 6 and 17 years of age. Unlike some other ADHD medications, it can take Guanfacine 4-8 weeks to reach maximum efficacy, though you may notice some improvements in your child’s ADHD symptoms sooner.

High blood pressure

Guanfacine was first approved to treat high blood pressure in adults in 1986 by the FDA. It is still used and frequently prescribed to treat high blood pressure to this day.

Other conditions

Although Guanfacine is primarily prescribed to treat ADHD and high blood pressure, it can also be used off-label for other conditions. Most commonly, Guanfacine is prescribed off-label to treat tic disorders and anxiety.

Is It Effective?

Prior to FDA approval for the treatment of ADHD, medications must undergo extensive research to confirm that they are effective to treat the condition. Multiple research studies show that Guanfacine extended-release tablets effectively treat ADHD symptoms in children and adolescents.

The ADHD Rating Scale-IV is one of the various tools used to measure ADHD symptoms and related behaviors in research. Studies using the ADHD Rating Scale-IV indicate that extended-release Guanfacine leads to significant symptom improvement when compared to a placebo group.

Guanfacine can be an effective treatment for ADHD symptoms on its own. In some cases, however, Guanfacine may be used as an add-on treatment to other ADHD medications. The reason for this is that research shows that Guanfacine can help reduce challenges with impulse control and hyperactivity that are not fully managed by other medications.

How Is Guanfacine Used for ADHD? 

There are two main ways Guanfacine extended-release tablets can be used to treat ADHD symptoms. Those taking Guanfacine may take it on its own (without other medications used to treat ADHD) or alongside another medication, often a central nervous system stimulant. If someone takes Guanfacine on its own, it may be because they had an adverse reaction to stimulant medications or did not find them effective. Again, using Guanfacine alongside central nervous system stimulants is also common among those with ADHD because it can help address some symptoms of ADHD that aren't managed by stimulant medications alone (e.g., impulsivity).

Since a combination of medication and therapy are usually the initial recommended treatment program for individuals with ADHD, your child's doctor will likely recommend therapy alongside Guanfacine.

Does Guanfacine Work Like Adderall?

No. While both medications can be prescribed to treat ADHD, they aren’t the same. People experience the effects of Adderall almost immediately, whereas Guanfacine (Intuitiv) takes longer to become therapeutic. The effects of Guanfacine also last longer than Adderall. Since the two medications work in the body differently, some individuals may react to one drug better than the other.  Read our full comparison of Adderall and Guanfacine.

Side Effects

Guanfacine is usually well-tolerated. As with any medication, Guanfacine extended-release tablets prescribed for the treatment of ADHD come with potential side effects. Some of the most common side effects of Guanfacine include:

• Dry mouth
• Drowsiness
• Nausea
• Dizziness
• Constipation
• Insomnia
• Lower blood pressure
• Weight changes
• Increased need to urinate
• Stomach pain
• Irritability
• Headaches

More serious side effects are rare but possible. If your child experiences fainting, blurred vision, slowed heart rate, or a rash when taking Guanfacine, seek medical attention or call their doctor immediately. Due to the potential for dizziness and drowsiness, it is important that individuals do not drive or otherwise operate machinery until they know how Guanfacine impacts them.

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Dosage

Guanfacine extended-release tablets come in doses of 1 mg, 2 mg, 3 mg, and 4 mg. As with most medications used to treat ADHD, a prescriber will start children and adolescents at the lowest dose and will increase the dose gradually until the dose is at the optimal therapeutic level for the individual. Starting at a low dose is meant to ensure that your child can tolerate Guanfacine. Guanfacine can be taken with or without food. Children taking Guanfacine usually do so once daily in the morning. A child's daily dose of Guanfacine should be adjusted based on weight as needed. 

Unlike stimulant medications, which sometimes allow for a drug holiday, a regular dosing schedule is important for those taking Guanfacine. 

What to do after a missed dose

If your child misses a dose, instruct them to take the next dose right away unless it is almost time for their next dose. Don't double up to make up for a mixed dose. Call your child's prescriber if they miss two or more doses consecutively. If a child misses two or more doses, they may need to restart treatment at 1 mg and move up to a therapeutic dose again.

If your child stops taking Guanfacine

It is strongly recommended that individuals taper off of Guanfacine rather than stopping the medication abruptly to avoid any potentially serious risks and consequences. Talk with your child's prescriber about how to stop taking Guanfacine safely. Most often, they'll taper your child off over a number of weeks.

Risks

Your child's doctor or prescriber should go over the side effects and risks associated with any medication before they start a new or change their medication routine. Most people who take Guanfacine extended-release tablets do not experience severe adverse effects, but as with most other medications, there are some potential risks. Here are some potential risks associated with Guanfacine:

Low blood pressure or low heart rate

Guanfacine can lower blood pressure or heart rate. Usually, any changes in blood pressure are nominal for those using Guanfacine treatment for ADHD and will not be a cause for concern. That said, around 1% of children taking Guanfacine experience orthostatic hypotension.

Drug interactions

Guanfacine can interact with a number of different drugs. Possible drug interactions include but aren't limited to other blood pressure medications, other drugs that contain Guanfacine, muscle relaxants, anticonvulsants such as valproic acid (Depakote) or carbamazepine (Tegretol), and other medications that can cause fatigue, such as those used to treat sleep disturbances or anxiety. Tell your child's prescriber about all of the other medicines and nutritional supplements they take, including over-the-counter items, to get individualized guidance on whether your child can take Guanfacine.

Food interactions

Guanfacine should not be administered with a high-fat meal. It is also recommended that individuals taking Guanfacine avoid taking their medication with grapefruit or grapefruit juice. Grapefruit and foods high in fat can increase the absorption of the medication. Talk with your child's prescriber to learn how to navigate possible food interactions.

Who should avoid Guanfacine?

There are some populations Guanfacine may be less suitable for. Those with a history of kidney disease, liver disease, fainting, heart problems, or stroke should proceed with caution before taking Guanfacine. Additionally, some people are allergic to Guanfacine. If your child is allergic to Guanfacine or any of its ingredients, they should not take the medication. When a provider prescribes Guanfacine or any other medication, it is because they feel the benefits outweigh the risks. Discuss any concerns you have with your child’s prescriber before they start taking Guanfacine.

Takeaway

Guanfacine is a non-stimulant prescription medication primarily used to treat attention deficit hyperactivity disorder (ADHD) and high blood pressure. It can be prescribed off-label for other conditions, too, including anxiety and tic disorders. Research shows that Guanfacine can lead to statistically significant improvements in ADHD symptoms in children and adolescents both as a standalone medication or alongside other ADHD medications. While it’s generally well-tolerated, those taking Guanfacine should be aware of side effects and risks, such as potential drug interactions.