Intuniv Tapering Guide
guanfacine
Overview
Guanfacine ER is a selective alpha-2A adrenergic agonist for ADHD (children, adolescents, sometimes adults) and an off-label add-on for hypertension and tics. Non-stimulant, non-controlled. Sedation and rebound hypertension on stopping are the main concerns.
1mg, 2mg, 3mg, 4mg ER tablets
ER tablets: 1mg, 2mg, 3mg, 4mg; IR tablets (Tenex): 1mg, 2mg
Category B
Mechanism of Action
Selective alpha-2A adrenoceptor agonist in the prefrontal cortex — improves working memory and impulse control by strengthening prefrontal connectivity.
Taper Notes
Step down 1mg per week. Do not stop abruptly — rebound hypertension is real.
Hyperbolic Tapering Guidance
A planned step-down avoids the cardiovascular rebound that abrupt discontinuation can cause.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Withdrawal Timeline
1-3 days
5-10 days
2-4 weeks
Sleep changes can persist 4-6 weeks
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- Strong CYP3A4 inhibitors — increase exposure
- Strong CYP3A4 inducers — reduce efficacy
- Other antihypertensives, CNS depressants — additive
Contraindications
- Known hypersensitivity
Toxicity
Sedation, hypotension, bradycardia, syncope, dry mouth, abdominal pain. Rebound hypertension on abrupt discontinuation.
Pharmacokinetics
ADME Profile
Hepatic via CYP3A4.
Need a clinician who understands tapering?
Browse our map of deprescribing-informed providers worldwide.
Other Drug Profiles
Sources & References
Intuniv (guanfacine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.