Skip to content

Guanfacine

    Brands

    DEA Class;  Rx

    Common Brand Names; Intuniv, Tenex

    • Alpha2 Adrenergic Agonists; 
    • ADHD Agents

    Oral, central acting alpha-2 adrenergic agonist
    Used for hypertension in adults; used for attention deficit hyperactivity disorder (ADHD) in pediatric patients 6 years and older and adult patients
    Similar to clonidine but is more selective for alpha-2 adrenergic receptors and longer-acting, which allows for once-daily dosing.

    Indicated for the treatment of hypertension.
    For the treatment of attention-deficit hyperactivity disorder (ADHD), as monotherapy or as adjunctive therapy to a psychostimulant.
    NOTE: Do not substitute immediate-release (IR) and extended-release (ER) products on a mg-per-mg basis; if converting from IR guanfacine, discontinue IR treatment and titrate with the ER product.
    For the treatment of Tourette’s syndrome or chronic tic disorders.

    Hypersensitivity

    • Xerostomia (10-60%)
    • Somnolence (5-39%)
    • Headache (0.2-26%)
    • Dizziness (2-15%)
    • Constipation (2-16%)
    • Fatigue (2-15%)
    • Abdominal pain (11%)

    Extended-release tablets

    • Somnolence (6-38%)
    • Headache (23%)
    • Dizziness (6-16%)
    • Decreased appetite (6-15%)
    • Fatigue (2-14%)
    • Abdominal pain (11%)
    • Hypotension (7%)
    • Asthenia (2-7%)
    • Impotence (0-7%)
    • Lethargy (6%)
    • Dizziness (6%)
    • Irritability (6%)
    • Nausea (3-6%)
    • Decreased appetite (5%)
    • Weakness (1-5%)
    • Insomnia (3-4%)
    • Bradycardia (3%)
    • Palpitations (3%)
    • Confusion (3%)

    Avoid abrupt withdrawal (can result in anxiety, nervousness, and rebound hypertension)

    May cause hypotension, orthostasis, bradycardia, and syncope, use with caution in history of cerebrovascular disease, recent MI, severe coronary insufficiency, or syncope

    Chronic renal/hepatic failure

    May cause sedation, especially at start; avoid operating heavy machinery

    Skin rash with exfoliation reported

    Avoid concomitant use with other CNS depressants (eg, alcohol) as they may potentiate CNS effects

    Risk of cardiovascular effects may increase when administered concurrently with antihypertensive medications or drugs that affect heart rate

    In post marketing experience, abrupt discontinuation of the extended-release tablets has resulted in clinically significant and persistent rebound hypertension above baseline levels and increases in heart rate; hypertensive encephalopathy reported in association with rebound hypertension with guanfacine

    There is pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications, during pregnancy

    There are no data on presence of guanfacine in human milk or effects on breastfed infant; effects on milk production are also unknown

    Adults

    3 to 4 mg/day PO (immediate-release); 7 mg/day PO of extended-release tablets (Intuniv) for ADHD.

    Geriatric

    3 to 4 mg/day PO (immediate-release). Safety and efficacy for ADHD has not been established.

    Adolescents

    3 to 4 mg/day PO (immediate-release); 7 mg/day PO of extended-release tablets (Intuniv) for ADHD.

    Children

    6 to 12 years: 4 mg/day PO of extended-release tablets (Intuniv) for ADHD.
    4 to 5 years: Safety and efficacy have not been established; however, doses up to 4 mg/day PO (immediate-release) have been used off-label for the treatment of ADHD.
    1 to 4 years: Safety and efficacy have not been established.

    Infants

    Safety and efficacy have not been established.

    Neonates

    Safety and efficacy have not been established.

    Guanfacine hydrochloride

    tablet (Tenex)

    • 1mg
    • 2mg