Guanfacine, sold as Intuniv, is an extended-release non-stimulant medication licensed for ADHD treatment in the UK. It works through a different mechanism from both stimulant medications and atomoxetine.

What it is and how it's used

Guanfacine was originally developed as a blood pressure medication, working on a specific type of noradrenaline receptor. Its effects on attention and impulse regulation were identified later, leading to its use — in an extended-release formulation — as an ADHD treatment. In the UK, Intuniv is licensed for children and adolescents aged 6–17 for whom stimulant medication is unsuitable, not tolerated, or hasn't been effective — it does not currently carry a UK licence for starting treatment in adults.

Medication class and mechanism

Guanfacine is a selective alpha-2A adrenergic receptor agonist. Rather than increasing dopamine or noradrenaline availability the way stimulants and atomoxetine do, it acts directly on specific noradrenaline receptors in the brain thought to be involved in attention regulation and impulse control. This distinct mechanism is why it's sometimes considered when other medication classes haven't worked well or aren't suitable.

UK brand and formulation

Sold in the UK as Intuniv, in an extended-release tablet form, taken once daily. The extended-release formulation is important — guanfacine in its original, non-extended-release form (used for blood pressure) is not the same product used for ADHD.

Prescription status in the UK

Guanfacine is prescription-only but not a Controlled Drug under UK misuse-of-drugs legislation. It's available on the NHS and privately, following the standard UK ADHD diagnosis and treatment pathway.

Common considerations

  • Guanfacine is often considered after stimulant medications and/or atomoxetine haven't been suitable or well tolerated, though its position in an individual's treatment plan is always a specialist decision.
  • Drowsiness and fatigue, particularly during the first weeks of treatment, are commonly reported — doses are typically started low and increased gradually to reduce this.
  • Blood pressure and heart rate are monitored during treatment, reflecting its original use as a blood pressure medication.
  • Stopping guanfacine abruptly isn't recommended — your prescriber will advise on tapering if treatment is being changed or stopped.

Safety and warnings

Because guanfacine affects blood pressure and heart rate, cardiovascular monitoring is a standard part of treatment, and it may not be suitable for people with certain existing cardiovascular conditions. As with all ADHD medication, it should only be started, adjusted or stopped under medical supervision.

Starting treatment

Guanfacine is started at a low dose and increased slowly, often over several weeks, partly to give the body time to adjust and reduce drowsiness as a side effect. Review appointments during this period typically check blood pressure, heart rate, and how sleepy or fatigued you feel, alongside whether ADHD symptoms are improving. If treatment needs to stop, your prescriber will usually recommend tapering the dose down gradually rather than stopping abruptly, to avoid a rebound in blood pressure.

How it fits into UK ADHD treatment

Guanfacine is one of two non-stimulant medications licensed for UK ADHD treatment, alongside atomoxetine. See our atomoxetine medication page for the other non-stimulant option, or the ADHD medication overview for the full picture of UK-licensed ADHD treatments.

Source: EMC — Intuniv SmPC.