Research has shown a reduction in ADHD symptoms in children who use the FDA-approved drug guanfacine. As part of a doctor-prescribed plan of treatment, guanfacine (also known by its brand names Intuniv and Tenex) may help improve your child’s lifestyle and reduce the symptoms of this common disorder. This medication is typically prescribed when stimulants are not an option or as a second, adjunct medication alongside a stimulant. Clonidine is a closely related non-stimulant option, and this guide covers both medications and how they compare.
Guanfacine vs. Clonidine: How They Compare
Guanfacine and clonidine are both non-stimulant medications called alpha-2 adrenergic agonists, and both were first used to treat high blood pressure. Extended-release versions of each (Intuniv and Kapvay) are FDA-approved to treat ADHD in children and teens ages 6 to 17, either on their own or alongside a stimulant. Guanfacine acts more selectively on one type of alpha-2 receptor, which may be why it tends to cause less sleepiness than clonidine. Both can lower blood pressure and heart rate, and neither should be stopped suddenly.
Guanfacine (Intuniv)
Introduction to Guanfacine and Its Uses
There are two types of Guanfacine on the market, Tenex and Intuniv, both of which are non-stimulant medications. While Tenex is an immediate-release oral pill used for treating high blood pressure in adults, Intuniv is the slow-release version of the pill used to treat the symptoms of ADHD in children ages six to 17.
Guanfacine is an effective alternative for children who cannot take stimulant medication such as Adderall and Ritalin as part of their ADHD treatment plan. It’s also an effective medication option for adolescents with substance use issues, medical disorders, and other contraindications. Although it’s not quite as powerful as stimulant medication, studies show that it’s better than a placebo.
So how does guanfacine work? To treat ADHD, guanfacine extended-release tablets should be taken orally once a day. The tablets affect the prefrontal cortex of the brain, which regulates thoughts and feelings, impulse control, mood, and the ability to plan and organize.
How Guanfacine Works in Managing Conditions Like ADHD
Those with ADHD can find it challenging to focus on tasks, frequently get distracted, battle to regulate emotions, prioritize tasks and time, and struggle with organization. Guanfacine calms the nervous system by targeting and stimulating the alpha-2A adrenergic receptors, thus regulating the flow of the norepinephrine neurotransmitter that is responsible for impulse control. The medication relaxes blood vessels and helps receptors in the brain better regulate emotions. Because of its effect on the brain, guanfacine can also alleviate nightmares, PTSD, and other anxiety disorders.
Guanfacine extended-release tablets can be used as part of a comprehensive treatment program to help manage behaviors.
The short-term use of Guanfacine Intuniv in adolescents can help with improving:
- Concentration and focus
- Impulse control
- Mood regulation
- Anxiety
- Aggression and hyperarousal
Guanfacine is not a cure-all and should always be treated as a second-line solution alongside a holistic treatment program tailored to the individual. Education, therapy, and other healthy lifestyle supports can help people successfully manage their ADHD. A dietitian can provide helpful dietary suggestions, and endorphins from exercise can improve calm and focus.
Common Side Effects and Considerations
Guanfacine is often a go-to for children who are not able to take stimulants. It’s worth noting that the medication is the most effective in children ages 12 years and younger, even though it’s available for children up to 17 years old. Before starting treatment, there’ll be a health screening to reveal any underlying heart and medical issues.
The most commonly reported side effects are sleepiness and dry mouth. Other common side effects include:
- Fatigue, low energy levels and exhaustion
- Sedation
- Nausea and stomach pain
- Headaches
- Constipation and digestive issues
More uncommon side effects include:
- Anxiety and nervousness
- Tremors
- Hallucinations (more common in children)
- Sweating
- Chest tightness
- Mood swings, irritability and short-tempered
- Decreased appetite
Side effects are usually mild, but if you or your child experience ongoing side effects after the initial adjustment period of one to two weeks, you should consult your healthcare provider. This non-stimulant medication is largely considered safe and does not have a black box FDA warning.
Tips for Safe Usage
If your child’s pediatrician or psychiatrist recommends guanfacine, let them know whether your child is taking other medications or has any underlying conditions. Like many psychotropic medications, guanfacine has interactions with certain drugs.
If you are given the prescription, it may take a week or two for your child to adjust, so be sure to monitor side effects. The dosage prescribed is based on weight; let your healthcare provider know if your child’s weight changes significantly.
For the safe use of guanfacine and to maximize its benefits, consider the following:
- No alcohol consumption or use of drugs—this may interfere with neurotransmissions.
- Never suddenly stop medication. Consult your physician and adhere to the prescribed weaning-off period; stopping suddenly can lead to increased blood pressure.
- Try to stick to a healthy eating routine. Guanfacine shouldn’t be taken with high-fat foods as the body could absorb it too quickly. It is intended to work via slow release.
- Pills should never be halved, crushed, or doubled. The exact, prescribed amount must be taken.
- Medication must be administered orally.
- Administer medication at the same time every day for maximum benefit. Before bedtime is advisable.
- Order new medication about two weeks before you run out.
- It’s best to take the pills with a full glass of water or liquid.
Typically, your child will start on a low dosage to monitor its effectiveness over a minimum of two weeks. If there’s no improvement, your healthcare provider may increase the dosage over time. Guanfacine extended-release is available in dosages of 1mg, 2mg, 3mg, and 4mg.
Clonidine (Catapres)
People living with ADHD commonly turn to stimulant medications to help them manage their symptoms. However, stimulants can’t always be taken or may not always work. Non-stimulant medication options like clonidine provide an alternative way to manage the symptoms of ADHD effectively without the same side effects or risks that may have made stimulant medication too dangerous or otherwise ineffective.
What Is Clonidine and What Are Its Uses?
Clonidine is a prescription vasodilator, essentially working by relaxing the blood vessels. It’s classified as an alpha-2 adrenergic agonist. Most typically, it is prescribed in tablet form, though it is available as a liquid medication. Your prescribed dosage depends on why you need it and can vary in frequency and quantity. Your doctor will tell you exactly how to take the medication and it’s essential that you follow their exact instructions.
Initially, it was used either alone or with other medications to manage high blood pressure. However, it’s also commonly used in an extended-release dose as a component of an attention deficit hyperactivity disorder (ADHD) treatment plan for people ages six and older. It can also be used off-label to treat other conditions, including:
- Dysmenorrhea (severe pain during menstruation)
- Hypertensive crisis
- Hot flashes during menopause
- Alcohol and opiate withdrawal
- Smoking cessation aid
- Prevent migraines
How Clonidine Works in the Body
Clonidine works by stimulating alpha receptors in the brain, causing them to relax blood vessels in the heart. As a result, blood pressure and heart rate decrease. Because its vasodilating effect extends to smaller blood vessels in the body, it can decrease hot flashes and migraines.
For people with ADHD, clonidine improves focus and reduces impulsive behaviors, though scientists aren’t exactly sure why it has these effects. However, it’s possible that the alpha-2 adrenergic receptors in the prefrontal cortex that clonidine stimulates may help with common ADHD symptoms like inattentiveness, impulsivity, and hyperactivity.
Because clonidine is considered a non-stimulant, it’s a second-line treatment for ADHD, commonly prescribed for people who either do not respond to stimulants or who can’t take them.
People with severe ADHD symptoms may also take clonidine with another stimulant medication, benefitting from a synergistic effect that can provide additional management. By adding clonidine to a treatment plan involving a stimulant medication, people benefit from improved focus and decreased distractibility thanks to the stimulant while clonidine assists with impulsivity and emotional regulation. However, to avoid any potentially dangerous medication interactions, only take clonidine with a stimulant that has been approved as part of your treatment plan by your doctor.
Common Side Effects and Precautions
Most commonly, clonidine is prescribed to adults ages 18 and older. However, children as young as six can take this medication when it is recommended by a specialist.
Before prescribing clonidine, your doctor will perform a thorough evaluation to determine if it’s right for you. Clonidine can pose a risk for those with certain medical conditions or who are taking certain medications, so be completely honest with your doctor during the questionnaire process. They will ask if you have or have ever had any of the following conditions:
- Brain bleed
- Heart disease
- Irregular blood pressure
- Slow or irregular heartbeat
- Kidney disease
- Allergic reactions
- Currently pregnant or trying to become pregnant
- Breastfeeding
- Have blood circulation problems such as Raynaud’s or peripheral arterial disease
- Clinical depression
- History of stroke, transient ischemic attacks, or brain aneurysms
Certain medications may increase the risk of a negative reaction to clonidine. Your doctor needs to know if you currently take any of the following:
- Monoamine oxidase inhibitors (MAOIs)
- Barbiturates
- Medications for blood pressure, heart disease, or irregular heartbeats
- Antianxiety, antidepressant, or antipsychotic medications
- Prescription pain medications
Of course, it’s essential that you tell your doctor about any medication use, including non-prescription drugs, dietary supplements, herbs, and other substances. They also need to know whether you drink alcohol, smoke, or use any illegal drugs, as these may increase the health risks of taking clonidine. Alcohol in particular is known to exacerbate clonidine’s side effects and may make you feel excessively sleepy.
Some people may experience side effects while taking clonidine. Common side effects are experienced by more than one in 100 people and tend to be short-lived and manageable. You may experience:
- Weakness, tiredness, or sleepiness
- Dizziness or feeling faint when standing up
- Constipation
- Dry mouth
- Erectile dysfunction for men
- Headaches
- Depression
- Insomnia or difficulty sleeping
If these symptoms do not get better with time or they’re too much for you to deal with, speak to your doctor about management strategies.
In rare cases, you may experience a serious side effect. These happen to less than 1 in 100 people and warrant immediate medical attention:
- Heart palpitations, an unusually slow heartbeat, or an irregular heartbeat
- Altered mental status, especially feeling confused, being unable to process the world around you, or experiencing hallucinations
- Stomach pain, vomiting, and constipation when experienced concurrently. This may be caused by a rare condition known as pseudo-obstruction of the large bowel.
While clonidine has a low potential for misuse and isn’t generally considered addictive, it is possible to overdose on this medication. It’s especially a concern if a child gains access to the medication prescribed for an adult. Overdose symptoms may include:
- Low blood pressure
- Decreased heart rate
- Sleepiness
- Difficulty breathing
- Nausea and vomiting
- Constricted pupils
- Dry mouth
This is considered a medical emergency and requires treatment. Contact your doctor immediately or contact your local emergency services. Do not try to drive yourself to the hospital after a potential overdose.
Importance of Medical Guidance When Using Clonidine
It’s important to seek medical guidance before using clonidine. A doctor can help determine if clonidine will help you with your medical condition, whether it is safe for you to take, and what your dosage should be.
Depending on the reason for taking clonidine, it could take time for you to see its effects. This is especially true when taking it for ADHD. While stimulant medications for ADHD often provide benefits with the first dose, clonidine often takes much longer. It can take several weeks before you start seeing the effects of clonidine once you determine the correct dosage. If your doctor recommends this medication, it’s a good idea to give it the time they recommend to see if it works for you.
Once you are taking clonidine, your doctor may recommend frequent blood pressure monitoring because this medication can cause it to lower.
Likewise, this medication can be dangerous to stop abruptly. If you’re considering stopping the use of clonidine, your doctor can create a plan that helps you slowly taper off and gives your body time to adjust gradually. Stopping suddenly can cause your blood pressure to increase dangerously while also leading to side effects such as:
- Heart palpitations
- Restlessness
- Agitation
- Shaking hands and tremors
- Headaches
- Nausea
If you’re trying to get pregnant or you become pregnant while taking this medication, your doctor will likely recommend you stop taking it. The effects of clonidine on pregnancy and fetal development are not yet conclusive. However, it’s especially important to taper off safely for the aforementioned reasons. Ultimately, your doctor will help you weigh the risks and benefits of taking clonidine while pregnant to help you make an informed decision.
Getting Help for ADHD
Clonidine provides a much-needed alternative to ADHD stimulant medications, or in some cases, works with stimulants to help people better manage their symptoms. While this medication is generally safe, it’s important to weigh the potential risks with the benefits before starting it, and your doctor can help you do this. Your doctor can also provide answers to any questions you have about starting, continuing, or stopping the use of clonidine.
If you are worried about issues related to ADHD and you don’t know where to start, don’t be afraid to ask for help. Restore Mental Health in Deerfield Beach offers psychiatric care and medication management as part of its treatment programs. Call (877) 810-2074 or contact us to learn more.
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