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Column originally published Oct 31, 2017

Intuniv XR Can Benefit Children With ADHD

Question: Our eight-year-old daughter has ADHD. She is not physically hyperactive, but she loves to talk. She argues all the time, and she believes she is always right. Her friends call her ‘Miss Right.’ I think we have a budding lawyer. She has been on Vyvanse which helps her to pay attention, and she argues less when the medicine is working. It does affect her appetite, and she is one of the smallest student in her class. Shortly after school started, her teacher called and said that the medicine is not working. She is not able to pay attention, and she distracts others; homework is becoming a challenge again. I have talked to her paediatrician, who suggested increasing the dose of Vyvanse, or add a second medicine called Intuniv. I am nervous about giving her one more medicine. What would be your advice?


It looks like you have a good understanding of your daughter. She has Attention Deficit Hyperactivity Disorder (ADHD), which makes it difficult for her to pay attention to learn in school and in doing homework. Although she is not physically hyper, she likely is hyperactive verbally. Her arguments can be part of impulsivity, but can also be part of oppositional character that coexists in many children with ADHD. It will be useful in the court room, but can be very annoying to her friends and family. She needs careful nurturing by her parents and teachers.

Vyvanse is an excellent ADHD medicine. At the right dose, it can work from morning until evening. When the medicine wears off, some children can become emotional or angry. It can reduce her appetite, especially at lunch; and it can affect sleep in some children. You can try to increase the dose of Vyvanse by 10 mg for a week (with your doctor’s permission), and see whether there is good improvement in her attention, both in school and at home, and monitor her appetite and sleep at the same time.

Sometimes, it is necessary to add a second medicine like Intuniv XR. This medicine was derived from a blood pressure medicine called clonidine, which has been around for a long time. Clonidine lowers blood pressure a little bit, but it makes people drowsy. As a result, doctors have used clonidine’s sedating side effect in children with ADHD who also have difficulty falling asleep. When clonidine was given to extremely hyperactive children in the daytime, they did calm down a little.

Scientists have modified clonidine into another medicine called guanfacine, which is less sedating and more effective in calming down children with ADHD. Unfortunately, guanfacine needs to be given 2 to three times a day to be effective.

Long-acting guanfacine, called Intuniv XR, became available several years ago. It is especially useful when combined with long-acting stimulants like Vyvanse and Concerta. Children can pay better attention not only in school, but also in doing homework and after-school activities. It helps children who are argumentative and oppositional. Some parents found that it can increase their children’s appetite, which is a bonus compared with stimulant medications.

Intuniv XR is especially useful when children have side effects with higher doses of Vyvanse or Concerta, like the ones that I mentioned earlier. The side effects of Intuniv XR tend to be very mild, especially if the dose is adjusted slowly. A few children can feel tired after taking it in the morning, but this usually disappears after a few days. Dizziness from lowering of blood pressure is also very mild and transient.

The only downside is the cost of two medications. Intuniv XR is quite expensive. Most private insurance will cover; but so far, almost no provincial pharmacy provides this medication.