Non-Stimulants to Treat Attention-Deficit Hyperactivity Disorder

Although stimulants are usually the first medications prescribed to treat ADHD, non-stimulants (e.g., Intuniv™, Strattera®) also may be used. These medications can improve attention and reduce impulsivity, hyperactivity, and distractibility in people with attention-deficit hyperactivity disorder. Non-stimulants do not carry a risk for dependence, their effects often are longer-lasting when compared to stimulants, and they usually do not cause agitation or difficulty sleeping.

In September 2009, guanfacine hydrochloride (Intuniv™) was approved by the U.S. Food and Drug Administration (FDA) to treat attention-deficit hyperactivity disorder in children and adolescents 6–17 years of age. This medication is used as part of an overall ADHD treatment plan that also may include psychological, social, and educational measures. It is usually prescribed for 8 to 9 weeks, and longer use has not been studied.

Intuniv is an alpha-adrenergic receptor agonist that is administered once daily as an extended-release tablet. Due to increased absorption of the medication, the tablets should not be crushed, broken, or chewed, and should not be taken with high-fat meals. The usual dosage ranges from 1–4 mg per day.

Possible side effects of guanfacine hydrochloride may include the following:

  • Abdominal pain
  • Constipation
  • Dizziness
  • Dry mouth
  • Excessive sleepiness (somnolence)
  • Low blood pressure (hypotension)

Studies have shown that Intuniv can help reduce symptoms of ADHD—at home and at school. In many children, behaviors associated with attention-deficit hyperactivity disorder begin to improve within 2 weeks. To reduce the risk for adverse reactions caused by the abrupt discontinuation of Intuniv abruptly, this drug should be gradually tapered.

Atomoxetine HCl (Strattera®) also may be used to treat ADHD in adults and children. Strattera is a non-stimulant that increases levels of the neurotransmitter norepinephrine. It is available in oral capsule form in several dosage strengths. Strattera usually is taken once or twice a day, with or without food.

Strattera should not be used in patients who take monoamine oxidase inhibitors (MAOI; e.g., Nardil®, Parnate®) or in patients with narrow angle glaucoma. It should be used with caution in patients with liver or kidney disease, certain heart conditions (e.g., tachycardia), high blood pressure (hypertension), or low blood pressure (hypotension). Strattera should be discontinued in patients who exhibit symptoms of liver damage (e.g., itchy skin, jaundice, dark urine).

Women who are pregnant, planning to become pregnant, or breastfeeding, should inform their physician before taking Strattera.

Side effects in children may include the following:

  • Abdominal pain
  • Decreased appetite
  • Dizziness
  • Fatigue (tiredness)
  • Headache
  • Mood swings
  • Nausea and vomiting

In adults, Strattera may cause the following:

  • Constipation
  • Decreased appetite
  • Difficult urination
  • Dizziness
  • Dry mouth
  • Fatigue
  • Headache
  • Insomnia
  • Nausea
  • Reproductive system disorders such as erectile dysfunction, prostatitis, and menstrual irregularities

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 01 Feb 2001

Last Modified: 16 May 2011