Guanfacine
Intuniv · Guanfacine extended-release
Alpha-2 Adrenergic AgonistGeneric available
Guanfacine is a central alpha 2A -adrenergic receptor agonist. Guanfacine is not a central nervous system (CNS) stimulant. The mechanism of action of guanfacine in ADHD is not known.
Compare Guanfacine →FDA-Approved Indications
- ADHD — mono or adjunct to stimulants (children/adolescents 6–17 years; ER formulation)
Common Off-Label Uses
- PTSD
- Tic disorders
- Anxiety disorders (pediatric)
- Impulse control
What Sets This Drug Apart
- Alpha-2A selective agonist (more selective than clonidine); FDA-approved extended-release (Intuniv) for ADHD in children 6-17
- Less sedating and less hypotensive than clonidine due to alpha-2A selectivity — better tolerated for daytime ADHD dosing
- Targets prefrontal cortex noradrenergic signaling to improve working memory and impulse control; mechanism distinct from stimulants
- CYP3A4 substrate — dose adjustment needed with strong CYP3A4 inhibitors (ketoconazole) and inducers (rifampin, carbamazepine)
- Useful adjunct to stimulants for residual hyperactivity, impulsivity, and oppositional behavior