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Intuniv for ADHD: Efficacy, Side Effects

Guanfacine or Intuniv Tablets

Intuniv for treating ADHD

Shire’s Intuniv medication is quite new.  It was approved recently, on September 3rd, 2009, but is gaining increasing recognition as a treatment for ADHD.

Chemically, Intuniv is an extended release form of guanfacine, a blood pressure med that has been on the market for quite some time.

It works by stimulating alpha-2 receptors – this lowers blood pressure and may work in the prefrontal cortex to increase focus, attention and memory.

Intuniv is one of many options for treating ADHD.  To learn what all the main options currently are (and, more importantly, what they do and how well they work), see a Full List of ADHD Medications.

And if you want to learn about ADHD in general, see here.

How well does Intuniv work?

Several studies so far have been done into how well Intuniv works for treating ADHD and what kind of side effects it has.

So far, they say that Intuniv works somewhat less than the stimulants like Ritalin and Adderall and – possibly – somewhat more than the traditional non-stimulants like Strattera.

This is important because, though they are the best current treatment for ADHD, 30% of people can’t take or don’t respond to stimulants.

Parents in particular have concerns about traditional treatment for their children.  Intuniv can be used as sole therapy or with stimulants, to round out treatment.

What kind of side effects does Intuniv have?

In general, the type of side effects that you’d expect from a blood pressure lowering medication.  That said, we’ve noticed a few issues you should know about and that you might not learn about elsewhere.

The pros

Intuniv could possibly fill a lot of the role as a non-stimulant treatment that Strattera was supposed to play but didn’t.  It has a long duration of effect and can even be used in combination with stimulants.

And the short acting form of Intuniv has been on the market for some time, so we know that it is fairly safe in general.

The cons

Intuniv is very new, and studies so far have shown that it is not as effective as the stimulants.  Some studies have hinted at potential problems such as high rates of serious side effects such as fainting.  While the short acting form has been on the market, Intuniv is long lasting.

Remember, roughly 50% of medication side effects are discovered after it is released onto the market.

Efficacy

How well does Intuniv work?

The studies seem to show that Intuniv falls just short of sending ADHD symptoms into remission.  Roughly 55% of those on Intuniv in one study reported significant improvement compared to 30% of those on placebo.

In one major study, on one scale, people who started with an ADHD score of around 40 and took Intuniv had their score go down to around 19 on average. The accepted number for remission of ADHD symptoms is a score of 18 or less.

Those who took Intuniv along with stimulants went from about a starting score of around 29 to around 13.

There are some more interesting hints towards Intuniv’s efficacy we found in that study.  On the one hand, only 10% of participants said that they stopped specifically because they thought Intuniv wasn’t working that well.  And of those taking Intuniv with stimulants, only one person stopped specifically because it wasn’t working well.

That said, around 80% of people in total dropped from that study.  It was done over two years, but that is still a somewhat high number.

Other studies into Intuniv have had much lower drop out rates.

In another, smaller study, roughly 30% of people on placebo reported significant improvement, as compared to around 55% of those treated with Intuniv.  This difference likely means that it has some benefit and is useful but falls short of the efficacy of the stimulants, which work in roughly 70% of those treated.

Analysis of that study concluded that at low doses Intuniv is about as effective as traditional non-stimulants, and at higher doses is superior to the current non-stimulants, such as Strattera, Wellbutrin, and possibly even Provigil.

Intuniv Side effects

Different studies show different side effect profiles for Intuniv.  Some say that it has about the same rate of issues as placebo, while others show that around 10-15% stop using it because of some side effect.  As far as psychoactive drugs, a 10-15% discontinuation rate due to side effects is on the lower/medium range.

The side effects of Intuniv also depend on its particular use.  When used in combination therapy with stimulants, for instance, it has much less rates of sedation and sleepiness, and users seem to report less problems.  This is probably because its sedative effects that lower blood pressure are counteracted by the stimulants effect of raising it.

Some of its side effects take time to start showing up, with sedation in particular starting after 3 weeks of treatment.

Most common:

30-40% report sleepiness

25% report headache

17% in one study reported upper respiratory tract infection

10% report sedation

Other common side effects include dizziness, nausea, irritability and reduced salivary flow.

Concerns

In one study, 5 participants out of 262 who took Intuniv  experienced syncope, or “temporary loss of consciousness.” In layman’s terms, they fainted or blacked out.

The clinical trials dedicated to exploring safety did not have such incidences, and it’s possible that the syncope events were environmentally based. One of the sufferers, after all, had a history of such issues. And guanfacine has a long history of use. So while those numbers are alarming, they are explainable.

Other possible side effects that may be an issue: head injury, suicidal ideation.

Like with all psychoactive medications, people using Intuniv should be monitored for anything abnormal like increased feelings of depression.

Dosing

Intuniv is given typically anywhere from 1-4mg/per day.  A dose typically lasts for 12 hours, but may have some effect for up to 24 hours.

Related articles:

  1. Vyvanse vs Adderall XR
  2. Dr. Tuckman Answers Questions About ADHD
  3. Is There a Physical Test for ADHD?
  4. The 4 Secrets to Success with ADHD

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126 comments

  1. @Missy:
    I can relate to a degree. My son initially was diagnosed with just plain old ADHD. Then the 2nd school that we went to insisted that he had ODD. i demanded a 2nd opinion with a different panel of specialists and they all agreed that he has classic ADHD – is the “poster child” for it according this neuro dr. that we saw. Anyway, when we put him on Concerta – it made him more hyper and aggressive. Certain stimulant meds do that = stim meds make them even more hyper = it did with my child… So I sometimes wonder: why bother medicating them with even more stimulants when they are already so very hyper in the first place? When we put our son on Intuniv, it no longer made him very hyper but more focused and he did very well this year in school. The tiredness, sleepiness in the afternoon, weird dreams, and a few bedwetting accidents at night but those were all the side effects that we experienced. So for us, we were pretty happy until he got used to the dosage, it just kept wearing off after about 2 months. The anger or destructive behavior that we experienced when he was on Concerta was gone. Sometimes despite the family situation, it is the meds that may make the kids more aggressive. Well, that’s my opinion anyways. Why not try just giving him the Intuniv alone but doing it at the lowest possible dose (2mg? for your boy) or try the next dose of 3mg and seeing what happens? Also by comboing some of the meds, it may not be good for your child while it works for others. It seems like your ADHD boy is not responsive to stimulant meds(my son is also not responsive to stim meds – they made him even more hyper which is not what we expected or desired – the additional side effects of not eating, not sleeping, and being angry/destructive/aggressive was almost too much for us to bear). My only other choice other than intuniv would have been VYVANSE because I heard from a few moms that some of their kids did well with it. I really did not know what to do because we already had gone thru Metadate, Focalin and Concerta without comboing and their side effects were not good for us. Also my son did weird things when eating, not picky or anything but just weird. Bathtime, he freaks out when I touch his hands to dry them afterwards, so I had that evaluated and found out that he has just a touch of sensory disorder. Also with ADHD kids, I am realizing that most of the people here that have posted have combinations of ADHD with something else. Please do not feel like you are alone! Just keep trying! Don’t lose hope! I hope that this helps….I’ve seen some of the other parents here giving the Intuniv at night so that the child benefits from the sleep maybe switiching the application of the med to a different time would help? I was also told for us to try Strattera but I’m too nervous about the “black” label where it warns about suicide. Adderal was another recommendation for us as well. I know that eventually when our time with Intuniv is over, at the rate that our child’s body is getting used to it. It will max out at 4 mgs, we will have to start all over again, so I’m thinking Vyvanse. Please let me know how it goes for you.

  2. For anyone looking for comments after several months of Intuniv:
    Our son, Jon (6 almost 7) has been on 2 mg since spring. We have noticed that the major downside seems to be tantrums/emotional supersensitivity. We are working through anger management with him but it’s a long road. Right now, he had to go down to 1 mg because of healthcare being cancelled (we’re trying to draw our supply out as long as possible) and we noticed the decrease in meds has given him quite a bit more energy (no more sleeping through church) but he still seems within the normal range for hyperactivity. He’s doing well in school so far. However, those things aside, we are talking about (if/when healthcare comes back) starting Vyvanse with Intuniv. We are hoping to work around some of this emotional overload (ie, little sister says “I like chocolate and Jon doesn’t” and we have tears and yelling immediately! yikes.)….anybody else found any help with this area?

  3. Katherine, ask your Dr. if they have any Intuniv rx cards. This card will allow you to get the meds for 15.00 a month for a year. I have insurance, and without the card it would be 54.00. Plus my Dr. gave me 3 months of samples in 1,2,3 mgs. Hope this os helpful too you.

  4. I have had my son on Intuniv since the miiddle of July and he is on 2mg right ;;now along with Adderal.

    I am not sure that this is the right combination. He has been having some of the tantrums and has been supersensitive too. But he has had a diagnosis of ODD for awhile. The other thing is that he is constantly complaining about his stomach hurting him, but his doctor said it is not the Intuniv. I am not so sure.

    As for the cost of it, it will cost me 63.00 a month with insurance. I have been having some trouble with getting the discount with my prescription card, but I will try again if he stays on it.

    The bedwetting could be a problem for us, I just don’t know if it is related, because my son was born with a bladder condition, called bladder exstrophy and has issues with control his urine, so he has to wear pads during the day and overnites at night. I am not sure how many people have bedwetting as a side effect, but if it is, it will only make things worse for my son.

    • Hi Barbara
      My son who is eight has just started intuniv and he is also taking prozac.
      He just started two nights ago and last night he peed his bed also. He hasnt done that since he was two and a half. and he had another *accident* also today
      i dont know if this is a side effect or not either

  5. Hello everyone I am trying INTUNIV with my child med that he’s already is taking. Hope that i get some release from school with this, may he will start doing better and stay focus and not talking so much……..

  6. Frances thanks for reporting the weird dreams and bedwetting issues at night. My daugther has been on Intuniv for @ 3 months now and has been experiencing weird dreams and crying spells at night. Also she has 1 accident recently that is unexplainable since she has not had an accident during bedtime in many yrs. I am thinking about taking her off the Intuniv because of these and other side effects. She also seems very pale during the day with an almost gaunt look on her face. Also dark circles around her eyes. I would advise other parents to really take a look at your children while they are on these meds to make sure they look themselves. The med seems to help her however the side effects outway keeping her on the meds.

  7. My son is 14 and has been on Intuniv for about a year. It has helped with hyperactivity and he is more focused. But I can tell he is more emotional and can’t sleep at night not sure if it is the med or the age. I’m thinking about taking him off of Intuniv too see if he is any better. He also takes Abilify and that works good for aggressivness. He can’t take stimulants makes if crazy. Has anyone had any trouble with the Intuniv and not sleeping?

  8. I wanted to post to thank the other parents who posted here. My son is 9 and on 25mg Adderal. He still wasn’t finishing his work so we upped it to 30 mg. Then the sleepless nights and temper tantrums started. emotional instability is almost too much to bear. talking about how life would be easier in heaven because people at school wouldn’t be inconsiderate… it makes me want to cry. I know intellectually it’s the drugs, but emotionally it’s hard on us too. doctor suggested intuniv at night and I have yet to figure out how to get him to swallow a pill whole. we break apart the capsule of adderral and put in applesauce as the dr. suggested, but intuniv says not to break it up or it will release too much at once. I’m exhausted and just knowing that other parents have been here is comforting. Thank you so much for your posts… tearing up as I write this. It gives me hope!

  9. You can try practicing pill swallowing with tic tacs!

  10. @ Jennifer… We had that problem too, and we transitioned by slowly decreasing the amount of applesauce, which introduced the texture of swallowing something more solid more slowly. Then added using water to wash the applesauce down… We also started putting half a capsule shell in there before decreasing applesauce, then up to a whole cap, and eventually no applesauce… I think you get the idea..  It worked great, and now our daughter swallows pills.  hope this helps!

  11. @Denise that is an excellent idea thanks! we did get him to swallow the intuitive whole at 1 mg. the two mg was twice as big and he swallowed that, but adderall pills are larger so I’m going to try that idea. I wouldn’t have thought of that.

  12. I have a 15 yr. old son with severe autism. He has been on Risperdal and Adderall for 5-plus years. His doctor is wanting to take him off Adderall to see if it helps with his agitation and irritability. He is suggesting I put him on Intuniv but after reading everybody’s blogs on here I am having serious doubts. My son is profoundly intellectually challenged. He has never talked and isn’t toilet trained either. It is very hard to tell what is hurting him when he is in pain. I can’t stand for him to be drowsy in school especially. I really am scared of even trying this medication now. There have been too many on here that have reported the same side effects. Anybody have any advice?

  13. Kathy,
    My son is on adderall. One thing you can do that my doctor recommended is SLOWLY reduce the adderral dosage as you ramp up intuitiv to see if YOU notice a difference. My son is only 9 so his ability to self-diagnose is extremely limited so it’s left up to my husband and I to watch him and interpret what he might be feeling.

    his adderrall reached a point of diminishing returns where he started having side effects after 25 mg but the teachers said he still couldn’t finish his work in a timely manner, was extremely distracted etc. when we increased it to 30 it was hell. He couldn’t sleep, was “wired,” started having suicidal thoughts etc. He had been fine on 25 mg so doctor recommended moving back to 25 mg and gave us a free trial of 1mg intuitive that ramped up to 2 mg over two weeks. we were to give it to him at night. Now he’s on 3 mg at night and still takes 25 mg adderall during the days. 3 mg does make him REALLY tired occasionally but does seem to help with focus.

    Anyway for your son, I’d recommend talking to your doctor about slowly reducing the dosage of adderall and implementing intuitiv over a few weeks so you can watch his reaction. When we stopped intuitiv, his reaction was as if he wasn’t on it at all… there weren’t any lingering side effects when we ran out of the 2 mg once.

    I think that’d probably be less of a shock to your son’s system as well. stopping adderall would be quite a shock to the system. Intuitive is a non-stimulant so it’s not going to give him the same immediate impact that adderall does when he takes it. Just thoughts from another mom. No medical degree, so of course talk to your doctor.

  14. My 6 year old has High Functioning Autism with PDD. Adderall didn’t work. Ritalin XR was working , but he now developed new behaviors so we are trying Intuniv XR 1 mg. He has a terrible gag reflex and I found that hiding medication in a spoon full of thick lemon pudding he can actually swallow a pill or capsule whole. Then he drinks some water. I put the pudding cup in a baggie for next time.

  15. @Kathy – I can see how adderall would cause irritability. My son does well on it but when the dosage got too high he became irritable and restless. backing off of it brought him back under control again.

    I haven’t had any bad side effects of irritability with Intuiv but did with Focalin that we briefly tried before that. I think each person’s chemistry is different so you won’t know what will work until you try it.

    If he’s irritable already, intuniv may work for his chemistry and it may not but you won’t know until you try it. The good news is, at least in my son, it only lasted 4-6 hours so even if you see he becomes extremely sleepy or restless, or any other symptom you may be afraid of, it will only last a day then you can stop it. I hope that helps.

  16. I just wanted to comment on the pill swallowing issue. My daughter is just starting med trials to see what works to help with her add. Adderall was first, but she also would gag and not be able to swallow the pills so I ended up breaking the capsule and pouring into applesauce but she would end up biting some of the granules in the applesauce. I wasn’t sure how much of it was really even ‘time releasing’. So I researched special cups to help you swallow pills and found ‘Oralflo’. I ordered the cup, $15, and may daughter is now on her 4th night of taking Intuiv and she is has swallowed the pill each night. It was hard, she still didn’t want to do it. But she did. So, long explanation, but I recommend buying the simple Oralflo cup online, it works!!

  17. My daughter struggled with swallowing her adderall as well. We learned that if she tips her head forward, the capsule floats to the back of her throat making it easy to swallow no matter the size. It only works with capsules not tablets.
    Good luck!

  18. melanie, my son has downs and he has been taking pills by putting it in applesauce and giving him a second spoonful of applesauce right away. It makes him swallow the first bit without thinking about it while focusing on the next bite. it has worked for years for us. but it has to be applesauce. we have tried puddings, etc and it makes him want to chew or hold the pudding in his mouth.

  19. My son has been on intunive almost since it was used for adhd and we thought it was wonderful but we are now being sent to a heart specialist. He didn’t have a heart problem until recently and i don’t know that the medicine that caused it yet but i have a serious issue with his doctors not once telling me it was a blood pressure and could affect his heart. I just want people to please maybe once a year or so have an ultrasound done on your childs heart to be safe.

    • Terri Brouchoud

      What problems was your son experiencing with his heart? My son is on intuniv as well, Nobody has ever mentioned to me about having an ultrasound yearly. But it certainly makes sense. Thank you for your information.

  20. my son is 7 and has ADHD and is in testing now bc they think he has asbergers. My son is ALWYS sleepy when he comes home from school. And moody bc he’s sleepy. But intuniv is the only thing that helps him. Stimulants jack him up. It took us almost a year to find what really works. I just wanna say that I’m very concerned about the heart problems bc my son has complained with chest pain b4 and when I took him to see the dr. They said he was fine. What can I do?

  21. Most doctors are willing to offer an ultrasound on the heart if heart problems are suspected, even if it’s just to allay your concerns. I am not aware of any heart problems linked to Intuniv, but I’m not an expert. All it would be doing is lowering your child’s blood pressure, which as the article mentions can cause fainting, but not necessarily heart/chest pain (which often is felt in other areas of the body, if it’s related to the heart, not necessarily in the chest). Just check with your doctor.
    What can you do? Well, I can share what we have done. Basically, we discovered that we can drug our child and put him in school, or we can leave him drug-free and educate him at home. We have tried both, although the only school we have had him in was a private one with a good teacher:student ratio…and even there he struggled. Rather than allow him to develop a self-image that was negative (“I’m stupid, I can’t learn” etc) we have chosen to allow him to learn at home for the time being. Many parents have told me that their child’s symptoms improved with age, so we may revisit that decision in a few years when his self-control has improved, but for now we are allowing him to pursue the things he is good at (i.e., Lego) at home in between the things he struggles with (like concentrating on reading…and being at home allows us to keep his reading material to subjects he wants to read). I figure, as long as God allows us the opportunity to help our son in this way, we will, because he has the rest of his life to catch up on subjects he struggles with, whereas if he develops a hatred for _learning_ now he will be seriously handicapped later on. That’s our take on it. I know this isn’t an easy decision for anyone, and obviously each child is different. :) God bless you in your struggles!

  22. HI!
    My son is eight and has been diagnosed with add and depression/anxiety. my son just recently started taking this medication. He was on strattera but it was losing its effectiveness so the doctor put him on adderall. it made him much much worse!
    but now after two days of him using it he has wet himself twice. Is this normal? he has not had an accident in a long long time *over five years!!!*

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