Can Intuniv (Guanfacine Extended-Release) Be Split or Crushed?
No, Intuniv (guanfacine extended-release) tablets should not be split or crushed, as this destroys the extended-release mechanism and can result in immediate release of the entire dose, potentially causing dangerous hypotension, excessive sedation, and loss of the intended 24-hour therapeutic coverage.
Why Splitting or Crushing Is Contraindicated
Extended-release formulations are specifically designed to deliver medication gradually over 24 hours, and splitting or crushing these tablets compromises this mechanism, leading to immediate release of the full dose 1, 2.
Guanfacine causes dose-dependent decreases in blood pressure (1-4 mmHg) and heart rate (1-2 bpm), and releasing the entire dose at once significantly increases the risk of clinically significant hypotension and bradycardia 1, 3.
The extended-release formulation is not substitutable on a mg-for-mg basis with immediate-release guanfacine due to different pharmacokinetics, making it impossible to safely convert a split extended-release tablet to an equivalent immediate-release dose 2.
Critical Safety Considerations
Splitting extended-release tablets can be harmful and in some instances very dangerous, as it eliminates the controlled-release properties that prevent adverse cardiovascular effects 4.
Patients experiencing excessive sedation (occurring in 5-38.6% of patients) should not attempt to split tablets to reduce the dose; instead, the prescriber should adjust the dosing schedule or consider switching to immediate-release formulations with appropriate dose adjustments 1, 5.
Alternative Approaches for Dose Adjustment
If a patient cannot swallow the tablet whole, discuss with the pharmacy about appropriate liquid formulations or switching to immediate-release guanfacine with adjusted dosing schedules (typically requiring multiple daily doses) 1.
Guanfacine extended-release provides once-daily dosing with around-the-clock coverage, and any modification to the tablet form eliminates this advantage and requires complete reformulation of the treatment plan 1, 2.
Evening administration is generally preferable to minimize daytime somnolence and fatigue, but the tablet must remain intact to maintain the extended-release properties 1.
Common Pitfall to Avoid
- Never allow patients to split or crush medications without explicit confirmation from the prescriber or pharmacist, as older adults and caregivers may attempt this to ease administration or reduce costs, unaware of the serious risks 4.