Maximum Dosing of Intuniv (Guanfacine) for ADHD
The maximum recommended dose of Intuniv (guanfacine) for treating ADHD is 7 mg per day, with a typical target dosing range of 0.05 to 0.12 mg/kg/day. 1
Dosing Guidelines
Initial Dosing and Titration
- Starting dose: 1 mg once daily 1, 2
- Titration: Increase by 1 mg per week based on response and tolerability 1
- Administration: Typically given at bedtime to minimize somnolence 2
Age-Specific Considerations
- Children and adolescents (6-17 years): FDA-approved in this age group 1, 3
- Adults: Limited data on efficacy and safety in adults; use with caution 1
- Preschool children (under 6 years): Not FDA-approved for this age group 1
Efficacy and Safety Considerations
Efficacy
- Guanfacine is effective for core ADHD symptoms and may help with oppositional symptoms 4
- As a non-stimulant medication, it has less abuse potential than stimulants 1
- Extended-release formulation (Intuniv XR) allows for once-daily dosing 3
Safety Profile
- Common side effects: Somnolence (up to 50.7%), headache (22.1%), sedation (13.2%), dry mouth, fatigue (11.0%) 3, 4
- Cardiovascular effects: Modest decreases in blood pressure and heart rate 3
- Growth effects: Less impact on growth compared to stimulants 5
Important Clinical Considerations
Monitoring Requirements
- Regular assessment of sedation and alertness
- Blood pressure and heart rate monitoring, especially during dose initiation
- Watch for signs of hypotension or dizziness 3
Discontinuation
- Avoid abrupt discontinuation
- Taper gradually to prevent rebound effects 3
- Rebound hypertension can occur 2-4 days after abrupt withdrawal but is less common than with clonidine 2
Special Populations
- Adolescents: Consider guanfacine for patients with substance abuse concerns due to its non-stimulant properties 1
- Pregnancy/Breastfeeding: Limited information available; use with caution after risk-benefit discussion 1
Clinical Pearl
When treating ADHD in patients with concerns about stimulant abuse or diversion, guanfacine (Intuniv) is one of the preferred non-stimulant options along with atomoxetine (Strattera), extended-release clonidine (Kapvay), or stimulant medications with lower abuse potential such as lisdexamfetamine (Vyvanse) 1.