Intuniv

Description

Generic Name
Guanfacine

Advantages
Tenex and Intuniv are only moderately effective for ADHD symptoms.
but it is a good alternative for very young children. It has the advantage that when used with a stimulant, guanfacine will minimize most of the stimulant side effects (insomnia, tics, irritability).

Disadvantages
Sedation and low blood pressure are the two most common side effects. Sedation is usually mild and if a stimulant is added, the sedation will disappear. Low blood pressure can cause light headedness or fainting, but this is not usually a problem at the low doses used to treat ADHD.

Excerpt from the book: ADHD Medications: Does It Work and Is It Save? Available on Amazon

Tenex is the brand name for another non-stimulant, guanfacine, that has been approved for the treatment of ADHD. Guanfacine has a chemical structure similar to clonidine and was also initially used as a treatment for high blood pressure. When the benefits of clonidine for ADHD were realized, studies of guanfacine confirmed suspicions that it would work for ADHD as well. Studies showed that it did have a posi- tive effect on reducing the hyperactivity and impulsivity of ADHD,10 but just like clonidine, the attention problems and impulsivity of ADHD showed minimal benefit from guanfacine when compared to stimulants. Everything discussed above for clonidine applies equally to guanfacine, with one exception. Guanfacine is a little less sedating than clonidine, so I often use clonidine if a child has sleep problems and guanfacine if not.
Children with ADHD are more likely to have tics, and guanfacine is an effective treatment for them. The irritability that occurs when stimulant medication wears off is usually minimized or eliminated with guanfacine. Stimulants almost always cause some appetite suppression, and although guanfacine does not increase appetite, it does stimulate the production of growth hormone.11 Stimulants can cause a mild increase in heart rate and, rarely, an increase in blood pressure. Guanfacine decreases heart rate and lowers blood pressure. Finally, guanfacine results in less sedation than clonidine, and if a child is on a stimulant with guanfacine, daytime sedation is almost always absent.

Intuniv is the brand name for extended-release guanfacine. It has all the benefits of Tenex (immediate-release guanfacine),12 but a single dose usually lasts nine hours, so a dose is not needed at school. Therefore, Intuniv can be started in the morning, and the beneficial effects will last most of the day.13 A second dose is often added in the early evening to help with any coexisting sleep problems (although clonidine is more likely to help with sleep).

Both clonidine and guanfacine are approved for children ages 6–17. However, when many physicians are confronted with a four- year-old who meets criteria for a diagnosis of ADHD they are often reluctant to use a stimulant because of the effect on appetite. Instead, it has become common practice initially to use Intuniv without a stimulant for pure ADHD in younger children. This probably works because if a child is diagnosed with ADHD as a four-year-old, the most troublesome symptoms are usually hyperactivity, impulsivity, anger, and aggression. Intuniv is an excellent treatment for those symptoms.14 Intuniv generally is not nearly as effective as stimulants for attention difficulties, but this is usually of less concern in a four- year-old. So, the younger the child with ADHD, the more likely he or she is to be started on Intuniv first, adding a stimulant later or switching to a stimulant as the child grows older and is confronted with more difficulty focusing and attending.
I have a different practice for young children with ADHD. Even though preschool children are less likely to be asked to attend for long periods of time, they still need to attend. And stimulants are still the best medications to help with the attention difficulties in ADHD. So, my feeling is why not start with the most effective medication15 (the stimulants methylphenidate or amphetamine) and if side effects occur, only then switch to Intuniv or add Intuniv to the stimulant treatment