Intuniv (Guanfacine) a Non-stimulant option for the Treatment of ADHD in Adults. MOA & Side Effects
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- Опубліковано 27 гру 2022
- Dr. Pagnani of Rittenhouse Psychiatric Associates discusses Intuniv (Guanfacine) which is an alpha-2 receptor agonist that can be used in the treatment of ADHD in Adults. Intuniv (guanfacine) is FDA approved in children, but off-label for treatment of adult ADHD. However, it may be a good option for Adult ADHD, particularly as it does not have the abuse potential that one finds with controlled stimulant medications like adderall, ritalin, vyvanse and concerta. Intuniv opposes the sympathetic tone, and results in smooth muscle relaxation. It's through this pathway that it can result in hypotension, bradycardia and other cardiac changes. It must be titrated (starting off at a very low dose, and slowly increasing) so that one's body (blood pressure & heart rate) can adjust. It can also cause other side effects, such as (but not limited to), headache, fatigue, upset stomach, constipation, irritability, rash, nightmares and others. It must be taken under the direct supervision of a trained medical provider.
Dr. Pagnani is the founder and medical director of Rittenhouse Psychiatric Associates, an Instructor at The Johns Hopkins Hospital for the Department of Psychiatry, he supervises psychiatric residents at Jefferson Hospital, he serves on the Young Professional Board of Uplift, the Center for Grieving Children and he maintains a private practice of Psychiatry in Philadelphia where he sees patients for one-time psychiatric evaluations and second opinions. He is a licensed physician and surgeon in NJ, PA, NY, MD, DE, FL and CA and can provide consultations to individuals via HIPAA compliant Telehealth visits living in these locations.
Rittenhouse Psychiatric Associates is a private practice of psychiatry consisting of about 25 psychiatrists, psychiatric nurse practitioners and psychotherapists with physical locations in Philadelphia and Paoli, PA and serving all of PA, NJ, NY and FL virtually via HIPAA compliant tele-psychiatry. Individuals seeking not only evaluations but long-term psychiatric care, can contact Rittenhouse Psychiatric Associates directly.
These videos aim to increase awareness and discussion of mental health topics and to encourage struggling individuals to schedule an appointment directly with a mental health provider. Mental health needs to be normalized, and simply speaking about mental health topics openly, is an important first step.
Dr. Pagnani and Rittenhouse Psychiatric Associates are NOT advocating for or against the use of any mentioned psychiatric medications for any specific individual. Additionally, any side effects mentioned are not a complete list of potential side effects or contraindications to taking any mentioned medications, and all risks and benefits of a medication should be discussed with an individual’s provider at an appointment, before starting, stopping or making changes to a medication regimen.
This video is INFORMATIVE ONLY - NOT MEDICAL ADVICE.
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24 y/o F with hypermobility-EDS, depression, anxiety, ADHD - currently on cymbalta (helps neuropathic pain), trileptal (helps stabilize my mood/impulses), and starting Intuniv tomorrow to start treating the ADD/ADHD. My MCAT is also in 12 days. This video was very helpful - I'll be sure to follow up on how guanfacine worked for me.
M, but much the same problems; though different regimen. On Mirtazapin + Vyvanse and combining with Intuniv starting tomorrow. Hopefully it'll help balance things out, as everything always seems to hit harder, even at low doses - except for analgesics where it's the opposite, I swear to god. Vyvanse is the only thing that's worked for my ADHD so far, but Jesus, I could do without the stim/side effects
@@SolidGoldHedgehog update?
@@buzzdown418 It helps a lot. First few days hit like a truck and felt exhausted, but it really helps take the edge off, reduce my anxiety. Most of all it manages and sometimes nearly eliminates many of my tics. My skin is actually slowly healing lol. But I can feel tired still, and have to watch my blood pressure as it can lower it (but I'm very sensitive to this stuff).
Guanfacine has been a game changer for me. I take it alongside Adderall. I first heard about it in a podcast with Dr. Russell Barkley and asked my psychiatrist to try it. Adderall works well but sometimes it just seemed like my internal restlessness got the best of me. Adding Intuniv really helps the Adderall do it's job. I think it also HUGELY extends the duration of the Adderall. I can often get by an entire day on one IR dose now. I would love to know the mechanism of action of why this would be (I am a nerd!). I don't think many doctors know about it outside of those psychiatrists who know ADHD well. My primary physician had never heard of it used for ADHD. Great video
Thank you for your comment and feedback! I think it's great that you would respond and let people know that sometimes non-stimulant options can be very helpful. - Dr. Pagnani
@@RittenhousePsych no problem, thanks
@@TroyHill442 I don’t think it actually extends to duration of stimulants at all. However it improves norepinephrine signaling and because it’s not a short acting medicine it helps cover the gaps left by stimulants when they wear off.
@@johnmoore1495 that's a good point. The most interesting thing about Intuniv is that it nearly eliminated my Raynaud's. This is something unrelated to stimulants - something I've had since a little kid. I believe it must be something with the sympathetic nervous system feedback system. Guanfacine is awesome. Memory effects are really profound. I actually somehow developed perfect pitch on this medication. My brother is a professional musician and music producer, and he's had this since Jr high school... But I never did. But this January I realized I could tune a guitar without a tuner or even a reference pitch. I have absolutely no idea how or why this is a thing, but it left me almost spooked out. I believe it may be something with memory? hey, I'll take it!!
@@DavidLombardo have you noticed any effect on your sweating? I take atomoxetine which makes me sweat like crazy but some people say Intuniv reduces their sweating.
Do you have any more information or studies about this medication. It’s been prescribed to my child and I really would appreciate anything you have that I can read about before starting it. Thank you looking forward to your response
Thank you for the informative video! Generally, do you have thoughts on the prescribing of guanfacine IR twice daily (as opposed to the once-daily ER version) for ADHD?
Thank you for watching and your question! Guanfacine can be utilized in both ER (once daily extended release) and IR (immediate release, usually twice daily) forms for ADHD. Most patients whom I prescribe this medication for are on the once daily version. However, some patients may prefer the immediate release version for various reasons. An example, could be someone who finds the medication very helpful for work, but feels more comfortable in social settings (or more interactive) when they are not taking it. So, they may utilize the immediate release twice daily on long work days, and just take it once daily (if they are only working for a few hours on others).
It's important for individuals to keep in mind, that in general, immediate release medications can have a quicker onset of side effects. For example, as guanfacine can lower blood pressure, different versions may cause individuals to have a more pronounced fluctuation in their vitals. This is why being under the direct care of a provider is so important.
Thanks again! - Dr. Pagnani
Will generic guanfacine work the same for adhd, or does it have to be brand name intuniv?
Hi Dr. Pagnani,
Are Clonidine and Guanfacine similar? Which one is best for ADHD ? As Clonidine is prescribed for high blood pressure and off label for ADHD and if Guanifacine’s main target is ADHD? They both lower blood pressure and I only want to take one med for my ADHD not adding more meds and currently only taking Clonidine but tempted to get switched over to Guanifacine after watching your video Which one is best for impulsivity? Thank you
I am not a Medical Doctor, however based on what I read they are both equally effective. However, Guanfacine has less side effects than Clonidine as Clonidine interacts with more receptors and may induce more fatigue and somnolence. I am currently on Guanfacine extended release and so far it is working well along side with my stimulant. Always make sure that you are taking an extended release version of this two to avoid sudden drop in BP. Hope this helps.
How do you know if your child needs a stimulants non stimulants or both this is concerning to me my youngest has been taking this for a while and my brothers and Dad have had cardio and respiratory issues my Dad had a heart attack and my brothers had clots in the lungs! Seems to be majority the male side my Dad also got clots in his legs.
I have a question doc i take intuniv and adderall daily i take the intuniv at 15:30 if i take it a hour later i can’t sleep at all why is that
Is weight gain something to worry about on 1 mg ?
I'm an adult who started on this med 1 week ago! Side affects lethargic and tired,hoping it will pass ! Starting 2 ml. In a few days
Hi does this fatigue last all day or just a short while after taking it. Also, do you take it in the am or before bed.
how are you now gina?
I tryed stimulants about a year ago and my heart went insane and i had terrible high bp and now im takeing intuniv and i am feeling light headed and low blood preshure 😭😭
Thank you for sharing. These side effects can be transient, and sometimes decreasing a dose, or very slowly titrating can be helpful. I recommend discussing all of this with your provider. There are additionally other non-stimulant options that you can discuss with them as well. Best, - Dr. Pagnani
Hey yo - why would guanfacine make my feet get dried and cracked when they were lush before starting? Does that have to do with the side effects of my big 8 inch record on the player not playing?
5 inch you mean
Could b three?@@paulharrisonadventuregearm5457
4 inch he means
Idk how anyone takes this crap. I took it once and was in a coma almost. My son sleeps so much with it or is grouchy cause he's tired