Adult ADD

A Guide to the Diagnosis and Treatment of Adult ADD

Guanfacine (Intuniv, Tenex)

Intuniv, a long acting form of guanfacine (Tenex), is a relatively new ADD medication so there has not been a lot of community experience with it.  Currently it is primarily used as an adjunct to the stimulants, which remain the first line treatment for ADD.   It is often used when the stimulants fail to have an optimal effect, especially when impulsivity is a problem.

The medication may take three or four weeks to have an effect.  This makes it somewhat difficult to judge its effects since it is sometimes difficult to compare a person’s condition before he started it with his condition four weeks or three months later.  For this reason, it can be useful for the patient and prescribing clinician to agree upon the specific target symptoms for which the medication is being prescribed and score them on a scale of 0 (no symptoms) to 5 (seriously disturbing symptoms) at the time the mediation is begun, then periodically afterward.  Using numbers can help since most people don’t have the words to describe the difference between various degrees of impulsivity.

Intuniv should be started slowly starting with 1 mg per day for about a week. If there is no or less than optimal effect, it can be increased to 2 mg for a few weeks, then to 3 mg or 4 mg per day depending on the patient’s response. The most common adult dose is 3 mg per day, but each patient’s dose needs to tailored individually.

The most common side effects are dryness of the mouth and tiredness.  To minimize the averse effects of the tiredness, some clinicians suggest patients take the medication at bedtime since the tiredness wears off more quickly than does the anti-impulsivity effect, which lasts well into the following day.  The sedative effect may be also be helpful to patients who have sleep problems, which are not uncommon among people with ADD.  In addition, stimulants make it difficult for some patients to fall asleep and Intuniv may help with that problem.

Stopping the medication suddenly does not appear to be a problem for most people.  However, it the person has high blood pressure and takes Intuniv, it may lower their pressure.  Then  stopping suddenly may result in a potentially dangerous elevation of the pressure.

Since Intuniv is not a stimulant, there are no problems with potential drug abuse, with phone-in refills, or prior authorizations.

 

Patient Notes

Increased converational ability A 19 year old college freshman (150 pounds) with ADD had reduced his daily dose of Vyvanse from 30 to 20 mg/day because he had lost about 7 pounds on it.  While on 30, he had been doing much better at school, had greatly improved concentration and focus, and was able to study “boring” material. The 20 mg dose reduced these effect, and Intuniv 1 mg in AM was prescribed to see if would heighten the effect of the Vyvanse without causing weight loss. It didn’t, but it did have a dramatically positive effect on his ability to bring thoughts and memories to mind during everyday conversations. He found this newfound ability to converse the biggest advantage of the taking a stimulant.  This is an important and not uncommon effect that some people have from the stimulants (including Vyvanse). However they never realize before they took them that this was a correctable symptom rather than their shy nature.

 

If you are being treated with Intuniv, let me know about your experience with it at MarcDSchwartzMD@GMail.com Or write a response in the comment box at the bottom right of the screen.