Intuniv for ADHD: Efficacy, Side Effects
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:
- Vyvanse vs Adderall XR
- Dr. Tuckman Answers Questions About ADHD
- Is There a Physical Test for ADHD?
- The 4 Secrets to Success with ADHD
Adhd and Add Online Diagnostic Test
Suffering from Adhd – need help – don’t know what to do!
Overcoming Adhd: A Guide For Parents
Control Your Add/adhd, Control Your Life!
@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.
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?
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.
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.
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……..