Guanfacine (Intuniv)

Mechanism of action

Selective alpha-2A adrenergic receptor agonist concentrated in prefrontal cortex. Activates the alpha-2A receptors that enhance working memory and attention. The mechanism produces ADHD benefit without dopamine modulation and therefore without abuse potential. Often used in combination with stimulants for additive benefit.

History

Guanfacine was originally approved in the 1980s for hypertension. The extended-release formulation (Intuniv) was approved for ADHD in 2009 after trials demonstrated efficacy. It's particularly useful for users with ADHD plus anxiety, tic disorders, or stimulant intolerance. Prescription required globally.

Benefits

• ADHD symptoms

  EVIDENCEA

  Multiple RCTs.

• Tic suppression in Tourette syndrome

  EVIDENCEB

  Multiple trials.

• Anxiety reduction in ADHD comorbidity

  EVIDENCEB

  Clinical experience.

Side effects

• Drowsinesscommonmoderate
• Hypotensioncommonmoderate
• Bradycardiauncommonmoderate

Cited research

• Guanfacine extended-release for ADHD (Sallee)2009
  PMID 19127201 ↗
• Guanfacine and prefrontal cortex function (Arnsten)2010
  PMID 21155764 ↗
• Guanfacine for tics in Tourette syndrome (Scahill)2001
  PMID 11581493 ↗

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