Intuniv for ADHD

ADHD Basics

Child with open medicine bottle.
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Intuniv is a long-acting form of guanfacine, which had previously been used to treat high blood pressure.

Intuniv for ADHD

Intuniv is a non-stimulant treatment for ADHD. It was approved by the FDA in September 2009.

It is initially approved as a once-a-day treatment for children and adolescents who are six to 17 years old with ADHD.

In 2011, Intuniv received the new indication for use as an adjunctive therapy for ADHD, meaning that it could be used with a stimulant ADHD medicine, like Concerta, Focalin, Adderall XR, or Vyvanse, etc.

Other things to know about Intuniv include that:

  • Guanfacine had already used off-label to treat children with ADHD who also have tics, sleep problems, and/or aggression.
  • Intuviv is a pill, but unlike some other ADHD medications, it can not be crushed, chewed or broken and must be swallowed whole.
  • Like Strattera and Kapvay, other non-stimulant for ADHD, Intuniv is not a controlled substance, which can make getting refills easier for parents.
  • Intuniv is available in four dosage strengths: 1mg 2mg, 3mg, and 4mg.
  • Most children will start Intuniv at the 1mg dosage and then increase by 1mg each week until they get to a target dose of 3mg or 4mg. Keep in mind that since you may have to increase the dose, it may take three or four weeks to see an improvement in your child's ADHD symptoms once he starts to take Intuniv.
  • In 2013, the FDA allowed more weight-based, flexible pediatric dosing, with maximum doses up to 7mg for older teens. Weight based target doses range from 0.05 to 0.12 mg/kg/day.

    It is often a benefit of Intuniv, unlike other ADHD medications, especially stimulants like Adderall, Concerta, or Vyvanse, that it does not cause much appetite suppression. That can make it a good choice for children who have problems gaining weight when taking a stimulant.

    And another benefit is that there will simply be one more option for treating children with ADHD.

    Intuniv Warnings and Side Effects

    Side effects of Intuniv most commonly include somnolence, which can occur in up to 38% of patients, headaches, fatigue, upper abdominal pain, nausea, lethargy, dizziness, irritability, decreased blood pressure, and decreased appetite.

    Although somnolence occurs in a large number of children when they start taking Intuniv, it seems to get better as they continue to take it. For some children, this is a benefit, as it helps them fall asleep if they are given their dose at bedtime (Intuniv can either be given in the morning or the evening).

    Warnings about Intuniv include that:

    • Intuniv should be used cautiously if your child is at risk for low blood pressure, bradycardia (low heart rate), heart block, or syncope (fainting), and those also taking ketoconazole, rifampin, valproic acid, antihypertensive drugs, or CNS depressants (sedatives, antipsychotics, etc.).
    • Intuniv should not be taken with a high-fat meal. It can be taken with water, milk, or other liquids.
    • Intuniv should be discontinued slowly, by decreasing or tapering the dose over several weeks, and should not be stopped suddenly.

      The last Pediatric Focused Safety Review by the FDA in 2013 recommended routine monitoring of Intuniv.

      Should Your Child With ADHD Try Intuniv

      Intuniv may be an especially good option if your child's current medication simply isn't working well, he hasn't been able to tolerate other stimulants because of side effects, or if you have been weary of putting your child on a stimulant.

      As with Tenex, we may also see Intuniv used to treat children with ADHD and tics, sleep problems, and/or aggression, either by itself or with a stimulant.

      Sources:

      FDA. Pediatric Focused Safety Review: Intuniv Extended-Release Tablets. Pediatric Advisory Committee Meeting September 2013

      Guanfacine Extended Release in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: A Placebo-Controlled Trial. Sallee FR - J Am Acad Child Adolesc Psychiatry - February 2009; 48(2); 155-165.

      Intuniv Full Prescribing Information Sheet. Accessed November 2009.

      Long-term safety and efficacy of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. Sallee FR - J Child Adolesc Psychopharmacol - 01-JUN-2009; 19(3): 215-26

      Safety and effectiveness of coadministration of guanfacine extended release and psychostimulants in children and adolescents with attention-deficit/hyperactivity disorder. Spencer TJ - J Child Adolesc Psychopharmacol - 01-OCT-2009; 19(5): 501-10

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