Guanfacine (Intuniv)
A non-stimulant ADHD medication, often used on its own or added to a stimulant.
What it treats
Guanfacine is approved by the U.S. Food and Drug Administration to treat attention-deficit hyperactivity disorder, usually shortened to ADHD, in its extended-release form.
Guanfacine was originally a blood pressure medication, and the immediate-release form is still used for blood pressure. This guide focuses on the extended-release form used for ADHD. When guanfacine is discussed as an ADHD medication, the extended-release version is what is meant.
How it works
Guanfacine is not a stimulant. It is an alpha-2 adrenergic agonist, which means it acts on a particular set of receptors in the brain. Those receptors sit in a part of the brain involved in attention and impulse control, and acting on them appears to support both.
Because it is not a stimulant, guanfacine is not a controlled substance and has no potential for misuse. That is one of the main practical differences between it and stimulant ADHD medications.
What to expect
Guanfacine works differently from a stimulant, so the shape of the first weeks is different too.
It is not fast-acting
A stimulant works the day you take it. Guanfacine does not. It is taken every day, and it takes a few weeks of regular use to reach its full effect. Daily, consistent use is what makes it work.
Common side effects
Most people get some side effects, especially early on. The common ones include:
- Drowsiness and sedation, which are common early in treatment.
- Tiredness.
- Dizziness.
- Dry mouth.
- Headache.
- Lower blood pressure.
Sedation is the side effect people notice most, and it is often strongest in the first weeks before easing somewhat. If a side effect is severe, or it isn't easing, that is a conversation to have with the prescriber rather than a reason to stop on your own.
Serious side effects and warnings
Serious problems are uncommon, but a few are worth knowing.
- Blood pressure and heart rate. Guanfacine lowers blood pressure and slows heart rate, so a prescriber will monitor both, especially when starting or changing the dose.
- Do not stop abruptly. Guanfacine should not be stopped suddenly. Stopping abruptly can cause a rebound rise in blood pressure. Any plan to stop should go through a prescriber.
- Sedation. The sedation can be significant, which matters for school, work, and driving. It is worth knowing how guanfacine affects you before driving or doing anything that needs full alertness.
Sexual side effects
Guanfacine is not a notable cause of sexual side effects. This is one area where it differs from some other psychiatric medications. If you do notice a change, it is still worth raising with your prescriber.
Weight, appetite, and sleep
Guanfacine is not a major cause of weight change. This is one difference from stimulant ADHD medications, which often reduce appetite.
It is sedating. That sedation is sometimes useful when ADHD comes with difficulty settling at night, and a prescriber may take it into account when deciding on timing.
Starting and dosing basics
This section is general background, not a dosing instruction for any individual. The right dose is a decision for a prescriber.
Guanfacine for ADHD comes as extended-release tablets. They are taken once daily and swallowed whole, not crushed or chewed. Guanfacine is started at a low dose and increased gradually. It should not be taken with a high-fat meal, because that can raise its levels in the body.
Missed doses and interactions
If you miss a dose, the general guidance is to take it when you remember, unless it is almost time for the next dose. In that case, skip the missed dose and carry on. Don't take two doses to make up for one. If you miss several doses in a row, do not simply restart at the same dose, and don't stop guanfacine abruptly. Check with your prescriber.
Other blood pressure medications can add to the blood pressure lowering effect. Other sedating medications can add to the drowsiness. Give every prescriber and pharmacist a full list of your medications and supplements.
Stopping and tapering
Guanfacine should be tapered, not stopped suddenly. Stopping abruptly can cause a rebound rise in blood pressure. A prescriber can plan a gradual step-down so the dose comes off safely. Even if you feel ready to stop, it is worth doing slowly and with guidance.
Pregnancy and breastfeeding
This is an area where individual circumstances matter and the decision belongs with a clinician. There is no single answer that fits everyone. Anyone who is pregnant, planning a pregnancy, or breastfeeding should talk it through with their prescriber so the specific risks and benefits can be weighed for their situation.
Cost and generic availability
Guanfacine is available as a generic. Intuniv is a brand name for the extended-release form. The brand and the generic contain the same active medication and work the same way. Coverage and price still vary by insurance plan and pharmacy.
Common questions
Is guanfacine a stimulant? No. Guanfacine is a non-stimulant. It works through a different mechanism and tends to be calming rather than activating.
Is it addictive? No. Guanfacine is not a controlled substance and has no potential for misuse. It still should not be stopped abruptly, for blood pressure reasons rather than addiction.
How long until it works? It is not fast-acting. It takes a few weeks of regular daily use to reach its full effect.
Can it be used with a stimulant? Yes. Guanfacine is often added to a stimulant, where it can help with hyperactivity and impulsivity. This is a common way it is used.
Why can't it be stopped suddenly? Stopping abruptly can cause a rebound rise in blood pressure. Guanfacine should be tapered with a prescriber instead.
Questions to ask your prescriber
- What are we hoping this treats, and how will we know it's working?
- Should I expect to take this on its own or alongside a stimulant?
- How will my blood pressure and heart rate be monitored?
- What should I do if the drowsiness affects school, work, or driving?
- If we decide to stop it later, how would we taper it safely?
Sources
This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes.
- U.S. Food and Drug Administration. Guanfacine extended-release (Intuniv) prescribing information.
- MedlinePlus, U.S. National Library of Medicine. Guanfacine.
- National Institute of Mental Health. Mental health medications.
Managing a medication needs a prescriber
Any psychiatric medication has to be started and adjusted by a clinician who can follow you over time. If you don't have a prescriber, our guides section explains the options, including in-person care and telepsychiatry, and how to choose between them.
This guide is for general education. It is not medical advice and is not a substitute for evaluation, diagnosis, or treatment by a qualified clinician. Never start, stop, or change a medication without talking to your prescriber. If you are in crisis or thinking about harming yourself, call or text 988 in the U.S. to reach the Suicide and Crisis Lifeline.