Facts, Side Effects, Cost, Dosing

What exactly is Intuniv?

Intuniv is a medication used to treat attention deficit hyperactivity disorder (ADHD) in children and adults. Unlike many ADHD medications, Intuniv is not a stimulant, although it is sometimes prescribed in combination with stimulant medications to treat the disorder. Intuniv comes in an extended release tablet that is taken once daily.

Is there a generic version of Intuniv available?

Yes, the generic version of Intuniv is called guanfacine and is available for purchase in extended release form.

When did the U.S. Food and Drug Administration (FDA) approve Intuniv?

Intuniv was first approved by the U.S. Food and Drug Administration in 1986.

Are there any major differences between Intuniv and stimulants used to treat ADHD?

Stimulants work quickly to treat symptoms, but they are habit-forming and have many side effects. They also might not be a good option for persons with other mental illness diagnoses or a history of substance use. Non-stimulants like Intuniv take longer for the effects to be felt, but they are not habit-forming. The most common reasons reported by people who discontinue Intuniv are drowsiness, sedation, and dizziness. Talk to your doctor about whether a non-stimulant, a stimulant, or a combination of the two is the best approach for treating your ADHD.

Can children take Intuniv?

Children over the age of 6 may be prescribed Intuniv for ADHD. They should take the medication in the exact amount prescribed by their doctor and adults should monitor for side effects.

Are there potential interaction issues for people taking Intuniv and any other drugs?

There are hundreds of drugs which are known to interact with Intuniv in major, moderate, or mild ways. These include antipsychotics, blood pressure medications, sedatives, ketoconazole, benzodiazepines, and barbiturates, among others. Tell your doctor what other medications you are taking before you begin Intuniv therapy.

Are there any other medical conditions that would make someone ineligible for Intuniv therapy?

Tell your doctor if you have low blood pressure, issues with fainting, kidney problems, heart problems, or liver problems before you take Intuniv.

What is the typical dose that would be prescribed to someone taking Intuniv?

The recommended dosage for Intuniv ranges from 1 to 4 mg once daily.

How long does Intuniv work?

Intuniv is designed to last for 24 hours.

What do I do if I miss a dose?

Take the dose of Intuniv when you remember, but skip the missed dose if it’s almost time for your next dose. You should never take extra doses of the medication to make up for missed doses.

What are Intuniv’s common side effects?

Common side effects of Intuniv can include:

• drowsiness

• sedation

• fatigue

• dizziness

• stomach pain

• sleepiness

• trouble sleeping

• low blood pressure

• nausea

If you experience major side effects, report them to your doctor immediately and stop using the medication. Major side effects can include low heart rate, low blood pressure, and fainting, among others. You can report side effects to the FDA at 1-800-FDA-1088 or online.

Are there any possible psychiatric side effects that come from taking Intuniv?

There is some report of increased depressive symptoms while taking Intuniv, but this is not a common side effect.

Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Intuniv?

There have been no controlled human pregnancy studies on the effects of Intuniv. It is not known whether the drug can be transferred via breast milk in small amounts and harm a baby. Therefore, talk to your doctor if you are pregnant, planning to become pregnant, or are nursing before you take Intuniv.

Can symptoms occur if Intuniv is discontinued?

Withdrawal symptoms of Intuniv can include headaches, tremors, agitation, and nervousness. Abrupt discontinuation can also cause a rapid increase in blood pressure, so maintain contact with your doctor and seek medical attention if necessary when discontinuing the drug.

What should I do if I overdose on Intuniv?

An overdose of Intuniv could be fatal, so seek help immediately or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include sleepiness, sluggishness, respiratory depression, bradycardia, and hypotension.

Is Intuniv habit-forming?

Intuniv is not a controlled substance and has no established potential for abuse.

How much does Intuniv cost?

One hundred 1mg tablets of Intuniv extended release cost approximately $1000.

Are there any disadvantages to Intuniv?

A major disadvantage of Intuniv is that it is expensive. Because it is not a stimulant, the medication also takes longer to produce effects, with some patients waiting up to a month to notice changes. Also, those who discontinue the drug often report increased sleepiness.

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other healthcare providers. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Notes: This article was originally published January 6, 2017 and most recently updated September 13, 2022.

Our Review Process

Guanfacine (Intuniv) for Attention-Deficit/Hyperactivity Disorder

ALLISON BERNKNOPF, PharmD, BCPS, Ferris State University, Kalamazoo, Michigan

Am Fam Physician. 2011;83(4):468-475

Author disclosure: Nothing to disclose.

Guanfacine (Intuniv) is an extended-release, non–central nervous system stimulant approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children six to 17 years of age; however, it appears to be most effective in children 12 years or younger. Similar to clonidine (Catapres), it works as a selective agonist for the α_2A-adrenergic receptor, although the actual mechanism of action is not known.

SAFETY

Guanfacine can cause hypotension, although it does not cause symptoms in most patients, and changes in blood pressure are usually small. Approximately 1 percent of children taking guanfacine will experience orthostatic hypotension. Syncope also occurs in about 1 percent of children, but it is not clear whether this is related to the drop in blood pressure or is a separate adverse effect. Changes on electrocardiography, including bradycardia, are rare but have occurred in clinical trials. Abrupt withdrawal of guanfacine should be avoided to decrease the risk of notable changes in blood pressure. Guanfacine is U.S. Food and Drug Administration pregnancy category B.¹

TOLERABILITY

Sedation is common with guanfacine treatment and can be severe in a small number of children. Somnolence and fatigue are also common, affecting 9 to 40 percent of children. ^2,3 These effects generally occur within two to three weeks of starting therapy and tend to decrease over time; most patients report not having these effects by the end of the eight- to nine-week treatment period.^2–4 The dosage should be slowly titrated up to avoid these adverse effects. In clinical trials, 12 percent of patients taking guanfacine discontinued therapy, compared with 4 percent of those taking placebo. The most common reasons for discontinuation were somnolence and sedation.¹ Patients on long-term (i.e., 12 to 24 months) guanfacine therapy reported adverse effects similar to those seen in shortterm studies, with somnolence, sedation, and fatigue being the most common. As with short-term therapy, the adverse effects from long-term therapy generally decrease over time.^2–6

EFFECTIVENESS

Guanfacine is effective in the short-term (i.e., eight to nine weeks) treatment of ADHD. Dosages of 1 to 4 mg per day decrease scores on the ADHD Rating Scale-IV by an average of 17 to 21 points, compared with a decrease of 9 to 12 points with placebo.^2,3 When adjusted for age, the changes in ADHD Rating Scale-IV scores were not statistically significant compared with the placebo group in patients 13 to 17 years of age, but were for patients six to 12 years of age. ^2,3 Therefore, effectiveness in children 13 to 17 years of age is questionable. Both physician ratings and parent assessments expressed marked improvement in more children receiving guanfacine compared with those receiving placebo. About twice as many children receiving guanfacine had statistically significant improvement on the Clinical Global Impressions Improvement scale. Similarly, 36 to 62 percent of patients taking guanfacine had statistically significant improvement on the Parent Global Assessment scale compared with 30 percent of those taking placebo.²

The duration of action of guanfacine, at least at lower dosages, is no more than eight hours, and higher dosages may be needed to produce sustained effectiveness.^2,3 Guanfacine has not been compared directly with other ADHD medications, including psychostimulant medications, clonidine, and atomoxetine (Strattera).

Guanfacine (2 to 3 mg per day) costs approximately $156 per month. Atomoxetine, the other noncontrolled substance used to treat ADHD, is similarly priced at approximately $203 per month for a dosage of 80 mg per day. A typical stimulant medication, methylphenidate extended-release (Ritalin SR; 20 mg per day), costs approximately $86 per month.

SIMPLICITY

The starting dosage of guanfacine is 1 mg per day. The dosage can be titrated up in increments of 1 mg per week to a maximum dosage of 4 mg per day. Tablets should not be chewed or crushed. Guanfacine should be given on a daily basis for the entire week, not just on school days, to avoid issues with returning or worsening somnolence and potential, but rare, increases in blood pressure. Patients who miss two or more consecutive doses may need to restart therapy at 1 mg per day and then titrate the dosage up based on patient tolerability. To discontinue guanfacine, the dosage should be tapered by 1 mg every three to seven days.¹

Guanfacine is an effective short-term treatment option for ADHD in children six to 12 years of age. Sedation is a marked problem in many children. Patients should take the medication daily to avoid adverse effects that occur with abrupt discontinuation or when the guanfacine is restarted.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

Composition of energy drinks | Tervisliku toitumise informatsioon

Most energy drinks contain caffeine, as well as a combination of other ingredients, incl. glucuronolactone, plant stimulants (guaranine, paraguayan holly-mate), simple sugars (glucose, fructose), amino acids (taurine, carnitine, creatine), biologically active plants (ginkgo biloba, ginseng) and B vitamins (e.g. nicotinic acid, vitamins B6 and B12).

Caffeine

Caffeine is a methylxanthine alkaloid whose chemical name is 1,3,7-trimethylxanthine. The highest concentrations of caffeine are found in beans and leaves of coffee plants, in tea, mate, guarana berries, kola nuts and cocoa. In total, caffeine is present in the beans, leaves, and fruits of over 100 plants, where it is believed to act as a natural pesticide that paralyzes and kills certain insects that eat those plants.

The main pharmacological effect of caffeine is stimulation of the central nervous system. The effects of caffeine can manifest itself in a spontaneous increase in the electrical activity of the brain, an increase in the risk of seizures, an increase in motor activity, as well as an increase in the speed of reaction.

Caffeine has a significant effect on the cardiovascular system. The following effects are noted:

• moderate increase in blood pressure (both systolic and diastolic),
• change in heart rate,
• neuro-endocrine manifestations such as the release of adrenaline, noradrenaline and renin.

In addition to the nervous and cardiovascular systems, caffeine also affects other organ systems. Caffeine increases breathing rate; through the excretory organs, in particular through the kidneys, caffeine removes sodium and water from the body. The stimulating effect of caffeine on the secretion of hydrochloric acid and pepsin in the stomach was noted.

The effect of caffeine on sleep is known. When a person consumes 400 mg of caffeine three times a day, sleep efficiency drops to a level equivalent to insomnia. Taking just before bedtime 300-400mg of caffeine has been associated with a 30-80 minute reduction in sleep time. Smaller doses can also affect sleep. 100mg of caffeine (i.e. a small cup of strong coffee) is known to delay falling asleep and impair sleep quality over the next 3-4 hours. In habitual coffee drinkers, caffeine does not affect sleep.

Large amounts of caffeine can have different effects, such as irritability, irritability, anxiety, restlessness, confusion, paranoia, hallucinations, tension, headache, dizziness, insomnia, loss of appetite, diarrhea, nausea, redness, hand tremors, circulatory problems, arrhythmias, low blood pressure, or insensitivity to pain. These symptoms can occur with both long-term and short-term use and may be signs of caffeine toxicity. Long-term abuse of caffeine can also lead to mental disorders in adults: sleep disorders and increased anxiety.

Children and adolescents who consume large doses of caffeine throughout the day may experience caffeine-induced headaches. Also noted are high blood pressure, insomnia, chronic headaches, irritability, learning problems, and an increase in other harmful side effects, many of which depend on the amount consumed.

In addition to children, caffeine use causes serious health problems in pregnant women (including miscarriage), nursing mothers, diabetics, patients with peptic ulcers, and people with cardiovascular diseases such as hypertension, heart failure, and cardiac arrhythmias.

For a healthy adult, 400 mg of caffeine is considered a safe daily dose.

Adult toxicity occurs at caffeine doses in excess of 7–8 mg per kilogram of body weight per day, ie 500–600 mg per day, equivalent to about five cups of coffee.

For children and adolescents, the dose of caffeine should not exceed 3 mg per kilogram of body weight per day.

The vast majority of energy drinks sold in Estonian shops contain 32 mg/100 ml of caffeine.

Guaranine

Guaranine is obtained from the guarana plant (Paullinia cupana) native to South America. Its seeds contain significant amounts of caffeine: 1 g of guaranine is equivalent to approximately 40 mg of caffeine.

In recent years, guaranine has been increasingly used as a natural ingredient in energy drinks due to its stimulating effect. Caffeine derived from guarana is excreted more slowly than pure caffeine, resulting in a longer lasting stimulant effect.

Guaranine is said to improve cognition and mood, as well as relieve mental fatigue. Guaranine has also been linked to improved lipid metabolism.

Taurine

Taurine is a sulfur-containing amino acid found in humans and many animals. Taurine, used in industry, is obtained by chemical synthesis, since the need for this substance is great.

Over the past 10 years, taurine has become increasingly common in energy drinks and can be found in very significant amounts in energy drinks. A study of 80 different energy drinks showed an average taurine content of 3180 mg per liter.

Taurine is involved in many physiological functions, incl. to neuromodulation, cell membrane stability and modulation of intracellular calcium levels.

Although there is no evidence of harmful effects of taurine on the human body, there is a concern that there is not enough research on the health effects of significant doses of taurine in conjunction with other components of energy drinks.

Ginseng

There are many types of ginseng, the most researched of which is Panax ginseng, also known as Korean or Asian ginseng.

Ginseng stimulates immune functions, improves physical and athletic endurance and general well-being, and improves resistance to environmental stressors.

In addition to the potential health-promoting properties of ginseng, its use has also been associated with adverse effects. We are talking about estrogen-like actions such as increasing the sensitivity of the breast and its soreness, the disappearance of the menstrual cycle, vaginal bleeding after menopause, breast growth in women. Other effects of ginseng consumption may include insomnia, palpitations, high blood pressure, swelling, headache, and dizziness.

Despite frequent claims by energy drink manufacturers that ginseng improves physical performance, studies have not found this to a noticeable extent. The amounts of ginseng contained in energy drinks are usually substantially less than those that could benefit or harm health.

Levocarnitine

This amino acid is mainly produced by the liver and kidneys to improve metabolism. Recent reliable research indicates that levocarnitine plays an important role in preventing cell damage and promoting recovery from training stress.

The positive effects of the amounts of this substance contained in energy drinks are not known. High doses of levocarnitine can cause nausea, vomiting, abdominal pain, diarrhea, and seizures have been reported.

Glucuronolactone

The human liver synthesizes glucuronolactone, which acts as a structural component of almost all connective tissue, from glucose. This substance is also found in some plants. Clinically proven that glucuronolactone reduces drowsiness, increases mental endurance and reaction speed.

A typical 250 ml can of energy drink can contain about 60 mg of glucuronolactone. The harm or benefit of glucuronolactone for human health has not been proven, since so far studies have only been conducted on animals.

B Vitamins

B Vitamins are a group of eight individual water-soluble vitamins that play an important role in cellular processes.

Since energy drinks contain large amounts of sugar, the B vitamins are considered to be the ingredients needed to convert this sugar into energy. Thus, B vitamins play a key role in releasing all the energy that is available in the simple sugars contained in energy drinks. This is where the notion of “extra energy” comes from, which energy drink manufacturers claim their products provide to consumers.

Vitamin B ₂ (riboflavin), vitamin B ₃ (niacin), vitamin B ₆ (pyridoxine), and vitamin B ₁₂ (cyanocobalamin) are commonly added to energy drinks as B vitamins.

While there is no harm in taking any of the B vitamins in large amounts, their presence in large amounts in energy drinks is not healthy.

Sugar

Most energy drinks contain sucrose, glucose and/or high fructose corn syrup. The exception is sugar-free energy drinks.

Ginkgo biloba

Ginkgo extract obtained from the leaves of Ginkgo biloba (Ginko biloba) has been used in traditional Chinese medicine for centuries.

Ginkgo extract is claimed to have antioxidant properties, improve vasomotor function, reduce adhesion of blood cells to the endothelium, inhibit platelet activity, and smoothen muscle cells.

The beneficial effects of the amounts of this substance contained in energy drinks are not known.

Paraguayan holly (mate)

Mate (sometimes mate, the emphasis is on the first syllable), also called Paraguayan tea, is made from the leaves of the Ilex paraguariensis plant, which accumulate significant amounts (0. 4-2%) of caffeine.

Paraguayan holly is rich in plant nutrients and has been linked to various health benefits. Mate has anti-inflammatory and anti-diabetic properties, suppresses oxidative stress.

Because of its high caffeine content, mate is a central nervous system stimulant and is the main reason it is added to energy drinks. The caffeine content in one cup (250 ml) of mate is approximately 78 mg.

Inositol

Inositol (formerly known as vitamin B ₈ ) is synthesized in the human body from glucose. Myo-inositol is part of cell membranes, it helps the liver process fats and promotes muscle and nerve function.

The positive effects of the amounts of this substance contained in energy drinks are not known.

Organic HESI Boost 5L

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Organic flowering and fruit ripening stimulator.

Hesi Boost strengthens buds, increases fruit sugar content and strengthens plants in general.

It is a flowering stimulator and at the same time a gentle fertilizer for plants in the flowering phase.

It is a mixture of fruit enzymes, vegetable sugars and fruit extracts.

Manufacturer

HESI

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Product Information

Description

Hesi Boost
Organic stimulator of flowering and fruit ripening.
Hesi Boost strengthens buds, increases sugar content in fruits and strengthens plants in general.
It is a flowering stimulator and at the same time a gentle fertilizer for plants in the flowering phase.
is a blend of fruit enzymes, vegetable sugars and fruit extracts.
Contains 1% phosphorus (P2O5) and 1% potassium (K2O) as well as natural minerals calcium, magnesium, iron, zinc, copper, molybdenum and selenium; B-complex vitamins: B1, B3, B6, as well as sugar, fruit enzymes such as galactolipid, and vegetable sugars such as raffinose and alginic acid.
The flowering period is the culmination of the plant’s life cycle, requiring enormous efforts from the plant. Hesi Boost has been designed to provide maximum support to plants during their flowering.

How exactly does Hesi Boost work?
Whole Plant: Hesi Boost strengthens plants to encourage vigorous, dense growth with many side shoots. This gives a good foundation for strong and resistant buds.
In the flower itself: Hesi Boost promotes the development of strong receptors and reduces their sensitivity to environmental conditions – the flowers become more resistant to external factors and their life span increases. Accelerates flower growth and stimulates their larger size.
For fruits: Edible fruits taste sweeter; they ripen more evenly and their quality is better. The stems become stronger and hold the fruit better. Decorative fruits do not deteriorate for a long time, they become larger and stronger.

Application:
1. To stimulate flowering use once at the beginning of the flowering phase. Then, from the beginning of the flowering phase, use no more than 1-2 times a week. For slow growing plants, once or twice a month is sufficient.
2. For edible fruits, at least 1-2 weeks before ripening. Proportions: 1-2 ml / 1 liter of water Shake the bottle before use.
Foliar application: spray on all parts of the plant, avoiding flowers.

Can be used simultaneously with other fertilizers and growth promoters.
Suitable for all growing methods: soil, hydroponics and coco.

Important! Due to the start of intensive growth processes, it is possible that after applying Hesi Boost, the plants will need more water.

Hesi Boost has a low nutritional value and does not replace the use of basic fertilizers.

Colour: Red-brown
Odour: Fruity
pH: Neutral
Electrical conductivity: Neutral

Store tightly closed, in the dark, at a temperature of 5-22C.
Keep out of the reach of children.

Made in the Netherlands.