Intuniv for ADHD in Adolescents

Non-stimulant Treatment for Children and Teens

Child with open medicine bottle.
Peter Dazeley/Photographer's Choice/Getty Images

Intuniv is a non-stimulant treatment for attention deficit hyperactivity disorder (ADHD). It is a long-acting form of guanfacine, which had previously been used to treat high blood pressure. It was approved by the FDA in September 2009.  It was initially approved as a once-a-day treatment for children and adolescents who are 6 to 17 years old and have ADHD.

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

Intuniv for ADHD

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, or aggression.
  • Intuniv 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-stimulants for ADHD, Intuniv is not a controlled substance, which can make getting refills easier for parents.
  • Intuniv is available in four dosage strengths: 1 milligram, 2 milligrams, 3 milligrams, and 4 milligrams.
  • Most children will start Intuniv at the 1-milligram dosage and then increase by 1 milligram each week until they get to a target dose of 3 milligrams or 4 milligrams. 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 7 milligrams for older teens. Weight-based target doses range from 0.05 to 0.12 milligram/kilogram/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.

Intuniv Warnings and Side Effects

Side effects of Intuniv most commonly include somnolence (which can occur in up to 38 percent 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:

  • 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 Pediatric Focused Safety Review by the FDA in 2013 recommended routine monitoring of Intuniv. The Pediatric Advisory Committee is reviewing this product in 2018.

    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 wary 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, or aggression, either by itself or with a stimulant.


    Childress AC. Guanfacine Extended Release as Adjunctive Therapy to Psychostimulants in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. Advances in Therapy. 2012;29(5):385-400. doi:10.1007/s12325-012-0020-1.

    Elbe D, Reddy D. Focus on Guanfacine Extended-release: A Review of its Use in Child and Adolescent Psychiatry. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2014;23(1):48-60.

    Huss M, Dirks B, Gu J, Robertson B, Newcorn JH, Ramos-Quiroga JA. Long-Term Safety and Efficacy of Guanfacine Extended Release in Children and Adolescents With ADHD. European Child & Adolescent Psychiatry. 2018. doi:10.1007/s00787-018-1113-4.

    Intuniv Full Prescribing Information Sheet. Shire US Inc.

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