Guanfacine vs. Adderall: What is the difference?

Guanfacine, under the brand name Intuniv, and Adderall are prescription drugs that treat attention deficit hyperactivity disorder.

Both drugs help treat the disorder, which people commonly refer to as ADHD, but they work in different ways.

In the case of Adderall, it is a stimulant. Conversely, guanfacine is a nonstimulant. In this respect, they are taken in different ways and may have different side effects.

The best option for each person depends on their specific symptoms, needs, and personal preferences. People usually use guanfacine only if stimulant medications are not appropriate.

This article discusses the differences, side effects, and dosages for guanfacine and Adderall.

What are they?

Woman examining medication pot of Guanfacine or Adderall.
Guanfacine and Adderall are medications that treat ADHD symptoms.

Guanfacine and Adderall are two medications that treat ADHD and several other conditions.

Adderall is the brand name for a combination of amphetamine and dextroamphetamine salts.

Intuniv is the brand name for guanfacine. Both drugs are also available in generic forms.

Adderall is a central nervous system stimulant. Doctors usually use stimulants to treat ADHD in children and adults.

Stimulants work by making it easier for nerve receptors in the brain to communicate, which can help control impulsivity as well as regulate attention and behavior.

Adderall takes effect relatively quickly. Adderall XR, a long-acting form of Adderall, is slower and lasts for longer.

Doctors may prescribe Adderall for conditions other than ADHD, such as the sleep disorder narcolepsy.

Other stimulant ADHD medications include:

  • methylphenidate (Ritalin, Biphentin, Concerta)
  • lisdexamfetamine (Vyvanse)
  • dexmethylphenidate (Focalin)

Guanfacine

Unlike Adderall, guanfacine is a nonstimulant. It is a central alpha agonist. Guanfacine increases and adjusts the number of neurotransmitters in the brain, which can help increase attention span and reduce impulsivity.

Guanfacine impacts nerve receptors in the brain less directly than Adderall, meaning it takes longer to take effect.

People taking guanfacine must keep track of their results while they are taking the medication to make sure they are meeting their treatment goals.

According to the American Academy of Family Physicians (AAFP), children aged 6–17 years of age can use guanfacine, and it may be most effective in children aged 12 years and under.

Tenex, another form of guanfacine, can help treat low blood pressure in people of all ages.

Other nonstimulant ADHD medications are:

  • atomoxetine (Strattera)
  • Clonidine (Kapvay)


Which is best?

Doctors will usually prescribe stimulants as the first-line treatment for ADHD. They may prescribe a nonstimulant, such as guanfacine, if the person cannot take stimulants, does not tolerate them well, or finds they are not effective.

Each person responds differently to ADHD medication, and it is not always possible to know which type is most appropriate before trying them.

Effectiveness

Both guanfacine and Adderall are effective in treating ADHD.

The Centers for Disease Control and Protection (CDC) estimate that 70–80% of children have fewer ADHD symptoms when taking fast-acting stimulants, such as Adderall.

According to the Food and Drug Administration (FDA), Intuniv reduced ADHD symptoms in children aged 6–17 in three well-controlled clinical trials that lasted up to 8 weeks.

Action

While Intuniv is typically slower to act than Adderall, its effects can last much longer, up to 24 hours. Adderall XR lasts longer than Adderall.

Abuse potential

Unlike Adderall, guanfacine use does not carry a high risk of abuse or dependence.

Adverse effects and warnings

People who are concerned about specific side effects or interactions with pre-existing medication can use these to help decide which drug is better for them. The following sections discuss side effects and interactions.


Side effects

A possible side effect of taking guanfacine is headaches.
A possible side effect of taking guanfacine is headaches.

Guanfacine can cause a wide range of side effects, including:

  • dizziness and drowsiness, especially at first
  • headache
  • irritability
  • low blood pressure
  • nausea
  • stomach pain
  • dry mouth
  • constipation
  • reduced appetite

In rare cases, guanfacine can cause:

Some side effects lessen over time but talk with a doctor about persistent, problematic, or uncomfortable symptoms.

If someone taking guanfacine has severe symptoms, they must talk to a doctor or seek emergency medical care.

Severe symptoms include:

Adderall can cause a wide range of side effects, most of which tend to lessen over time as the person’s body becomes used to the drug.

The side effects of Adderall and other stimulant medications can include:

  • stomach pain
  • loss of appetite
  • trouble sleeping
  • slightly higher heart rate and increase blood pressure in children
  • slower overall growth in children, which is usually temporary

Talk to a doctor or seek emergency care if someone develops severe side effects that doctors associate with stimulant use, such as:

  • significant increases in heart rate or blood pressure, fatigue, or shortness of breath
  • panic attacks, hallucinations, paranoia, delusions, or mania
  • changes in the feeling or color of fingers or toes
  • signs of dehydration, dark urine, weakness, or severe muscle pain
  • prolonged erection

Anyone who intentionally or unintentionally overdoses on Adderall or guanfacine medication needs emergency medical care.

Call Poison Control on 1-800-222-1222 for immediate advice on how to care for someone who has overdosed on ADHD medications, even if they have only taken a bit more than their usual dose or they seem fine.


Drug interactions

Adderall can interact with the following medications:

Intuniv can interact with the following medications:

  • CYP3A4 inhibitors, such as ketoconazole and fluconazole
  • CYP3A4 inducers, such as rifampin and efavirenz

Can you take both?

Doctors can prescribe Intuniv as an adjunctive therapy alongside stimulant medication.


Dosage

A doctor will often gradually adjust someone’s dosage until they find one that does not cause many side effects.

Adderall is available in both immediate-release (Adderall) and extended-release (Adderall XR) forms:

  • Adderall is available in tablets of 5, 7.5, 10, 12.5, 15, 20, and 30 milligrams (mg).
  • Adderall XR is available in capsules of 5, 10, 15, 20, 25, and 30 mg.

Intuniv is available in extended-release tablets of 1, 2, 3, and 4 mg.

How to take them

Guanfacine and Adderall must be taken in quite specific ways, as follows:

Adderall

Some people take Adderall early in the morning with food.
Some people take Adderall early in the morning with food.

People usually take Adderall and Adderall XR once or twice daily with or without food, usually in the early morning and early afternoon.

  • Swallow Adderall tablets whole, without crushing or dividing them.
  • Swallow Adderall XR capsules whole or open and sprinkle them on food.

If someone misses a dose of Adderall, they should take their medication as soon as possible, unless it is after 5 p.m. as stimulants may make it difficult to sleep.

If someone misses a dose of Adderall XR, they should not take the missed dose after 2 p.m. as it may interfere with sleep.

Guanfacine

People usually take guanfacine once or twice daily, with or without food, ideally at the same time each day.

Taking guanfacine with a high-fat meal may increase how much the body absorbs the drug, which may increase its effects.

If someone misses a dose of guanfacine, they should take the missed dose, as soon as possible, unless it is close to their next dose.

A person must never take more of ADHD medications than prescribed or share medications with anyone else.


Complications

Misuse of stimulants may lead to serious adverse heart events and sudden death.

Stimulants also carry the risk of addiction and emotional or physical dependence, especially if someone has taken them for a long time.

People taking Adderall or guanfacine should avoid using illegal drugs or drinking alcohol because doing so can reduce the benefits of their medication and increase adverse side effects.

Some side effects associated with guanfacine can make people less alert.


Pregnancy

Researchers know little about the risks of using stimulants during pregnancy. However, stimulant abuse during pregnancy is associated with low birth weight, neonatal withdrawal symptoms, and premature birth.

No well-controlled studies have looked at the impact of guanfacine on pregnancy, though it seems able to pass into breast milk. Stimulants such as Adderall have been shown to concentrate in breast milk and can harm a child.


Outlook

Guanfacine (Intuniv) and Adderall are prescription medications to treat ADHD. Each has benefits and risks.

When discussing medication, a doctor will take many factors into account to find the most appropriate drug for an individual. This includes their symptoms, needs, pre-existing medical conditions or medications, and their preferences. They will also look at how a person has reacted to other ADHD medications in the past.

It often takes several weeks for people to find the right dosage of each medication. They may then start experiencing the full benefits weeks to months after beginning treatment.

Medications, such as Adderall and guanfacine, help manage ADHD symptoms, usually as part of a treatment plan that also involves non-medications therapies, including behavior and complementary health approaches.

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