Guanfacine and Intuniv: Evidence-Based Uses in ADHD, Mood Disorders, and Beyond

At Alpine Psychiatry, we’re committed to offering integrative, evidence-informed care for ADHD and co-occurring emotional challenges. Guanfacine and its extended-release formulation, Guanfacine ER (brand name Intuniv), are non-stimulant medications most often used to treat ADHD—but their applications reach far beyond.

Whether you're navigating impulsivity, irritability, mood dysregulation, or brain fog related to Long COVID, Guanfacine may be part of a personalized treatment plan that balances medication, therapy, and lifestyle interventions.

What Is Guanfacine?

Guanfacine is an alpha-2A adrenergic receptor agonist originally developed to treat high blood pressure. When formulated as Guanfacine ER (Intuniv), it provides sustained support for mental health conditions by calming overactive brain circuits—especially in the prefrontal cortex, which governs attention, regulation, and executive function.

FDA-Approved Use: ADHD in Children and Adolescents

Guanfacine ER is FDA-approved for treating Attention Deficit Hyperactivity Disorder (ADHD) in individuals aged 6 to 17. It helps reduce hyperactivity, improve focus, and manage impulsive behaviors. Studies show that 60–70% of patients experience significant improvement when treated with Guanfacine ER.

Unlike stimulants, Guanfacine is less likely to cause appetite loss, insomnia, anxiety, or tics—making it a gentle but effective option for many families.

Learn more about ADHD treatment at Alpine Psychiatry.

Off-Label Applications in Mental Health

While Guanfacine ER is only FDA-approved for pediatric ADHD, clinical use and research support its off-label use for other conditions:

Anger and Intermittent Explosive Disorder (IED)

Guanfacine may reduce emotional reactivity and aggression, especially in children and adolescents who experience explosive outbursts.

Disruptive Mood Dysregulation Disorder (DMDD)

In DMDD, a condition marked by chronic irritability and temper episodes, Guanfacine may help stabilize mood and reduce the frequency of behavioral dysregulation.

Long COVID and Cognitive Impairment ("Brain Fog")

Emerging studies suggest Guanfacine may improve attention, working memory, and executive functioning in patients experiencing post-COVID cognitive symptoms.

Dosing Guidelines

Children (6–12 years)

• Start with 1 mg once daily

• May increase by 1 mg per week

• Max dose: 4 mg/day

Adolescents (13–17 years) and Adults

• Start with 1 mg once daily

• Titrate gradually based on response

• Max dose: 7 mg/day

Important: Guanfacine ER should not be crushed, cut, or chewed, as it's designed for extended release. It can be taken with or without food, but consistency is key—take it the same way every day.

Common Side Effects

While well tolerated, Guanfacine may cause:

• Sleepiness or sedation

• Dizziness or lightheadedness

• Headache

• Fatigue

• Abdominal discomfort

These effects typically resolve with continued use or dose adjustment.

Who Should Use Guanfacine with Caution?

Guanfacine can lower blood pressure, which may lead to dizziness or fainting—especially in patients with:

• Low baseline blood pressure

• Postural orthostatic tachycardia syndrome (POTS)

• Heart conditions (e.g., bradycardia)

• Kidney or liver impairment

Regular monitoring is recommended during dose changes. At Alpine, we may suggest tracking blood pressure at home using a reliable monitor.

Integrative Psychiatry Perspective

At Alpine Psychiatry, Guanfacine is often part of a broader, personalized care plan. We take into account sleep, nutrition, gut health, trauma history, and co-occurring conditions when developing treatment strategies. Depending on the individual, we may pair Guanfacine with:

• Cognitive-behavioral therapy (CBT)

• Parent coaching and behavior interventions

• Functional medicine labs

• Lifestyle coaching for sleep, nutrition, and stress

Final Thoughts

Guanfacine and Intuniv offer a unique and flexible option for treating ADHD and mood-related symptoms in both children and adults. Whether used as a first-line agent or as part of a broader integrative treatment plan, Guanfacine’s calming effects on the nervous system can make a meaningful difference in daily functioning and emotional wellbeing.

If you’re curious whether Guanfacine is right for you or your child, we’re here to help. Contact Alpine Psychiatry to learn more about personalized treatment options.