INTUNIV Attention Deficit Hyperactivity Disorder

ADHD written on medical clipboard

ADHD written on medical clipboardShire pharmaceuticals has announced the release of a new medication for Attention Deficit Hyperactivity Disorder (ADHD). They have received FDA approval to market and sell INTUNIV which is a long acting form of the medication guanfacine. Guanfacine is a medication that is used to treat high blood pressure but has long been used as a third or fourth line treatment for ADHD when stimulants, Strattera, or imipramine were unsuccessful or could not be tolerated or safely used. It has a chemical cousin, clonidine, which also has been used.

Now guanfacine has been approved as a first line treatment.

Guanfacine has been approved for the use in children and adolescents ages 6 – 17. It is thought to work by affecting norepinephrine receptors in the prefrontal cortex, an area thought to be implicated in ADHD. Guanfacine is not a controlled substance, is not a stimulant, and has no abuse potential. Like many medications it has its potential drawbacks as well. Common side effects are sedation, headaches, fatigue, upper abdominal pain and small changes in heart rate and blood pressure. In some patients it can cause a potentially dangerous drop in blood pressure and heart rate leading to fainting episodes. It should not be mixed with any other medication that can lower the blood pressure or heart rate.

Having another option for ADHD, particularly one that is not abusable is welcome.

It is good to have another first line treatment. It does bring up the point I have made before about the need for caution in using any of the ADHD medications as they all have some effects on the cardiovascular system. It is my belief that all patients who are going to take these medications should have a pre-screening electrocardiogram to help rule out any underlying heart disease. Not everyone agree with me about this. The American Heart Association does but the pediatric and pediatric psychiatry organizations have not yet adopted this viewpoint. I hope they will.

Thought For the Day

All medical treatments have risks as well as benefits.

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