Intuniv (guanfacine ER) Full Prescribing Information DailyMed Drug Information Forms/Strengths Tablets: 1 mg, 2 mg, 3 mg, 4 mg  Dosing Age: ≥ 6 y/o Duration: ~ 24 hours Considerations: Avoid high-fat meals; do not crush, chew, or break tablets Initial Dose: 1 mg daily  Titration: 1 mg/week Max Dose: 25 - 33.9 kg: 2 - 3 mg/day 34 - 41.4 kg: 2 - 4 mg/day 41.5 - 49.4 kg: 3 - 5 mg/day 49.5 - 58.4 kg: 3 - 6 mg/day 58.5 - 91 kg: 4 - 7 mg/day 91+ kg: 5 - 7 mg/day Quick Facts Guanfacine (Intuniv) is a selective alpha-2A adrenergic receptor agonist; enhances prefrontal cortex regulation Reduces impulsivity and hyperactivity; may be less effective for inattention Non-stimulant option for ADHD; useful as adjunct therapy with stimulants Primarily metabolized by CYP3A4; dose adjustments may be necessary with CYP3A4 inhibitors or inducers Common side effects: drowsiness, fatigue, hypotension, dry mouth Indications   ADHD (ICD-10: F90.0) Off-Label Uses Oppositional Defiant Disorder (F91.3): May help manage irritability, anger outbursts, and impulsive aggression. Anxiety Disorders (F41.9): Sometimes used to reduce symptoms of anxiety and related somatic complaints.   Tic Disorders/Tourette’s Syndrome (F95.2): Occasionally employed off-label to help reduce tics.   Autism Spectrum Disorder-Associated Irritability (F84.0): May help in managing irritability and aggression in some cases. How to Take Take once daily , preferably at the same time each day . Swallow the tablet whole ; do not crush, chew, or split. Take with or without food , but be consistent with food intake to maintain stable absorption. If a dose is missed , take it as soon as possible unless it is close to the next dose—do not double up. Do not abruptly stop taking; tapering may be required to prevent rebound hypertension . Side Effects Common: Sedation, somnolence, headache, abdominal pain, hypotension, bradycardia. Serious: Syncope, rebound hypertension, cardiac conduction abnormalitie Monitoring / Labs Cardiovascular : Baseline and routine monitoring of heart rate and blood pressure. Psychiatric Symptoms : Observe for mood changes, anxiety, or psychosis. Education When to Call the Doctor: Severe dizziness, fainting, or low blood pressure . Slow or irregular heart rate. Excessive drowsiness or difficulty waking. Mood changes, depression, or unusual behavior. Severe headache, blurred vision, or confusion ( possible hypertensive rebound if stopped abruptly ). Safety Tips: Monitor blood pressure and heart rate regularly. Avoid alcohol and sedatives , which may enhance drowsiness. Rise slowly from sitting or lying positions to prevent dizziness. Use caution when driving or operating heavy machinery due to possible sedation. Taper gradually when discontinuing to avoid withdrawal symptoms. Parent Tips for Pediatric Patients: May cause daytime drowsiness ; consider giving the dose at bedtime if drowsiness is problematic. Monitor for irritability, mood swings, or behavioral changes . Encourage hydration and balanced nutrition to minimize side effects. Ensure children do not engage in high-risk activities (e.g., swimming, biking) if excessively drowsy . Additional Information Contraindications: Hypersensitivity to guanfacine or formulation components. Use with caution in patients with severe heart disease, bradycardia, or hypotension . Pregnancy: Category B ; no well-controlled studies in pregnant women, but animal studies suggest minimal risk. Lactation: Excreted in breast milk ; use with caution due to potential effects on infant blood pressure. Drug Interactions: CNS depressants (e.g., alcohol, benzodiazepines) may increase sedation. Beta-blockers may enhance bradycardia; caution when using together. Stimulants (e.g., amphetamines) may counteract guanfacine’s effects. Antihypertensive medications may lead to excessive blood pressure lowering.