--- title: "Guanfacine vs Clonidine: What's the Difference & Which Is Better?" description: "Learn how guanfacine and clonidine compare for managing ADHD and anxiety, including their differences in effectiveness and side effects." authors: - "Saya Des Marais" reviewers: - "Laura Maleknia" date: "2024-10-03 11:45:43" canonical: "https://medvidi.com/blog/guanfacine-vs-clonidine" categories: - "Medications" --- # Guanfacine vs. Clonidine for ADHD and Anxiety The medications listed on this website are provided for informational purposes only.Their inclusion does not guarantee they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. Healthcare providers may prescribe other medications or recommend non-pharmacological treatment based on the patient’s unique health circumstances and needs. [Read more](#) ### Highlights - Guanfacine and clonidine are both alpha-2 agonist medications that work to lower blood pressure. In their extended-release form, they’re approved to treat attention deficit hyperactivity disorder (ADHD) in children and adolescents aged 6 to 17. - These two medications are very similar and are used for the same purposes, but have some differences, including mechanism of action and dosage. - Guanfacine and clonidine are best used in conjunction with other ADHD treatment methods like behavior therapy. If you live with attention deficit hyperactivity disorder (ADHD), then you may already know that stimulant medication (like Ritalin or Adderall) is an effective treatment to help you manage your symptoms. However, many people can’t or don’t want to take stimulants for various reasons. You might not like the side effects, or you may not want to risk the potential for abuse and addiction. Fortunately, there are non-stimulant medications available to treat ADHD. Guanfacine and clonidine, sold under the brand names Intuniv and Kapvay, are two non-stimulant medications that are FDA-approved to treat ADHD in children and adolescents, and research suggests they could be helpful for adults with ADHD as well. Learn more about how guanfacine and clonidine compare when it comes to ADHD and anxiety treatment and how to know if these medications might be helpful for you. See a licensed healthcare provider online to go through an assessment and learn what treatment option is right for you. [ ** Book an appointment ](https://join.medvidi.com/signup) ## Guanfacine and Clonidine: Key Features Guanfacine and clonidine belong to the same category of medication: alpha-2 adrenergic agonists, or simply alpha agonists. In their extended-release form, they’re respectively sold under the brand names Intuniv and Kapvay. These types of medications work by activating alpha-2 receptors in the brain. The activation of these receptors inhibits the release of norepinephrine, which is key in reducing both hyperactivity and impulsivity, the key [symptoms of ADHD](https://medvidi.com/adhd/symptoms/). This also helps to lower blood pressure. Extended-release guanfacine and clonidine may also be used off-label to treat anxiety disorders, post-traumatic stress disorder, and tic disorder. These medications share many similarities. Both guanfacine and clonidine are [non-stimulant options](https://medvidi.com/blog/how-do-non-stimulant-adhd-medications-work) used to treat [attention deficit hyperactivity disorder](https://medvidi.com/adhd/). Both of them are only FDA-approved to treat children and adolescents. However, healthcare providers can prescribe any of these for adults with ADHD if it’s deemed appropriate based on the assessment. **Brand name** **Intuniv / Tenex** **Kapvay / Catapres / Onyda** What is the generic drug? Guanfacine Clonidine What forms does it come in? Extended-release tablet (Intuniv); immediate-release tablet (Tenex) Extended-release tablet (Kapvay); immediate-release tablet and skin patches (Catapres); oral suspension (Onyda XR) What strengths does it come in? 1mg, 2mg (Tenex) 1mg, 2mg, 3mg, 4mg (Intuniv) 0.1mg, 0.2mg, 0.3mg (Catapres) 0.1mg, 0.2mg (Kapvay) Who can take it? 6 to 17 years olds with ADHD; adults with high blood pressure; may have other off-label uses 6 to 17 years olds with ADHD; adults with high blood pressure; may have other off-label uses What is the dosage? Starts at 1 mg per day Starts at 1 mg per day What is the typical length of treatment? Long-term Long-term How do I store this medication? At room temperature in an air-tight container At room temperature in an air-tight container Is there a risk of withdrawal from this medication? Yes Yes *Note that the dosages are provided for informational purposes only. Always consult with your healthcare provider to determine the most appropriate dosage individually.* "As a clinician, I often remind patients that medication for ADHD works best when combined with behavioral strategies. While guanfacine and clonidine offer non-stimulant options, individualized treatment plans are key for managing symptoms effectively." * [**Laura Maleknia, CRNP**](/team/laura-maleknia/) Healthcare provider at MEDvidi ## An Overview of Guanfacine [Guanfacine](https://medlineplus.gov/druginfo/meds/a601059.html) is a medication that was originally used to treat high blood pressure. As we mentioned earlier, it’s a type of medication that stimulates alpha-2 adrenergic receptors in the brain. These receptors are like switches in the brain that control things like heart rate and the width of your blood vessels. This helps lower blood pressure. Guanfacine extended-release tablets, sold under the brand name Intuniv, are used to treat ADHD. Researchers still don’t understand exactly how guanfacine works to reduce ADHD but it’s been shown to reduce its symptoms like inattention, restlessness, and impulsivity in children and teens. Extended-release guanfacine (Intuniv) is only FDA-approved to treat ADHD in children and adolescents 6 to 17 years old. This is because we don’t yet have enough research showing that it’s helpful for ADHD in adults. But because immediate-release guanfacine (under the brand name Tenex) is approved to treat high blood pressure in adults, many physicians prescribe it “off-label” for adults with ADHD. Guanfacine can also be used off-label for anxiety disorders, post-traumatic stress disorder (PTSD), and tic disorder. ## An Overview of Clonidine Like guanfacine, [clonidine](https://medlineplus.gov/druginfo/meds/a682243.html) is also an alpha-2 receptor that lowers blood pressure and adrenaline. It widens your blood vessels so that blood can flow through your body better. In its immediate-release form, sold under the brand name Catapres, it’s used for high blood pressure. The extended-release form of clonidine, Kapvay, is used to treat ADHD symptoms in children and adolescents aged 6 to 17. Researchers don’t fully understand how Kapvay works for ADHD, but it’s theorized that it affects the area of the brain called the prefrontal cortex that’s implicated in ADHD. Kapvay has been found to reduce symptoms like hyperactivity and impulsivity. On top of treating ADHD in young people and reducing blood pressure, clonidine is also FDA-approved to treat: - Tic disorder- Cancer-related pain- Neonatal opioid withdrawal syndrome [Off-label, clonidine is used to treat](https://www.ncbi.nlm.nih.gov/books/NBK459124/) anxiety, PTSD, restless leg syndrome, menopausal hot flashes, and vascular migraine headaches. Get personalized mental health care online in 24 hours. [ * Book an appointment ](https://join.medvidi.com/signup) ## Clonidine vs Guanfacine for ADHD Both extended-release clonidine (Kapvay) and extended-release guanfacine (Intuniv) have been [found to be effective](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204383/) for reducing ADHD symptoms in children and teens, both as adjunct treatments and on their own. These medicines interact with the brain in similar ways, and one isn’t necessarily better than the other for ADHD. However, there are some differences to be aware of when looking at Kapvay vs Intuniv. [Clonidine affects multiple types of receptors](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526381/), which helps calm both the mind and body but can lead to stronger side effects. Guanfacine, however, is more selective and focuses on just one type of receptor that plays a key role in attention and impulse control. Both medications can be helpful for ADHD, but some people find that guanfacine comes with fewer side effects. Some studies have also found that [guanfacine for ADHD](https://medvidi.com/blog/guanfacine-intuniv-for-adhd-how-does-it-help) has unique benefits that clonidine may not have, like [improving planning and working memory](https://www.nature.com/articles/1395310). Although these medications haven’t been approved for adult ADHD, research suggests that it could be helpful. For example, one [2020 Japanese phase 3 study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531113/) found that guanfacine significantly improved adult ADHD symptoms with no safety concerns.  Both medications have been found to be effective for treating ADHD. However, neither of them are as effective as [stimulant medications](https://medvidi.com/blog/stimulants-for-adhd-how-do-they-work). Stimulants can also come with a risk of addiction and abuse as well as more severe side effects. This is why some people may prefer to take alpha agonists like guanfacine or [clonidine for ADHD](https://medvidi.com/blog/pros-and-cons-of-clonidine-for-adhd). ## Clonidine vs Guanfacine for Anxiety Clonidine, especially in its immediate-release form, has shown some efficacy in reducing anxiety in acute settings, such as with PTSD. However, both clonidine and guanfacine can only be prescribed for anxiety off-label, so other medications like benzodiazepines and SSRIs are more commonly used as first-line treatments. Some studies have found that clonidine, including in its immediate-release form as [Catapres](https://medvidi.com/blog/catapres-clonidine-for-anxiety-uses-facts-and-side-effects), [can be effective for reducing anxiety](https://www.ncbi.nlm.nih.gov/books/NBK531717/). Other studies have found that [Intuniv](https://medvidi.com/blog/intuniv-guanfacine-for-anxiety) can be [effective for children with anxiety disorders](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695796/). In simple terms, clonidine and guanfacine may help calm down the body’s “fight-or-flight” response by reducing the activity of certain nerves in the brain that control stress and anxiety. However, it’s important to consider that neither clonidine nor guanfacine are considered a first-line treatment for anxiety disorders. They are sometimes prescribed off-label for anxiety and should be used only when clinically appropriate. There may be more effective treatments available, including benzodiazepines like [Xanax](https://medvidi.com/blog/xanax-for-anxiety) and antidepressants like [Paxil](https://medvidi.com/blog/paroxetine-paxil-for-anxiety-uses-dosage-side-effects). ## Side Effects Both guanfacine and clonidine can come with side effects. However, one of the reasons that people may choose to take these medications over stimulants is that they may come with fewer or less intense side effects. The side effects of these medicines are similar, since they’re the same class of medication. Here are some of the most common ones, along with the percentage of people each affects. **Side effect** **Guanfacine** **Clonidine** Drowsiness Yes (38%) Yes (38%) Headache Yes (24%) Yes (20%) Fatigue Yes (14%) Yes (16%) Abdominal pain Yes (11%) Yes (15%) Dizziness Yes (8%) Yes (7%) Dry mouth Yes (2%) Yes (5%)* Constipation Yes (3%) Yes (6%)* Irritability Yes (6%) Yes (9%) Decreased appetite Yes (5%) Yes (4%) Sleep terrors No Yes (3%) Nausea Yes (5%) Yes (5%) Diarrhea Yes (4%) No Nightmares No Yes (9%)* Tearfulness No Yes (3%)* Poor quality sleep No Yes (3%) *Only at .04mg/day [Source: [DailyMed Intuniv Label](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1bb3fac5-11e8-4d1c-a5e4-2520abcdeb47#); [DailyMed Clonidine Extended-Release Label](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0100c70d-7fde-46a1-8374-940550a27e43#LINK_907ddb1b-9121-438f-b86d-c4e75e68d30e)] ## Drug Interactions Because guanfacine and clonidine belong to the same category of medications, they interact with other substances in similar ways. If you’re taking another medication or supplement, even if it’s over-the-counter, let your healthcare provider know. They can help you make necessary dosage adjustments or prescribe a different medication when necessary. In addition, other types of medications can have dangerous interactions with guanfacine and clonidine, which can cause certain side effects, including dizziness and low heart rate. They can also make one or the other of the medications less effective. **Medication** **Guanfacine** **Clonidine** CYP3A4 inhibitors, including grapefruit juice X X Central nervous system depressants X X Blood pressure medications X X Beta blockers X X Tricyclic antidepressants X X CYP3A4 inducers, including St. John’s Wort X X ### Can You Take Clonidine and Guanfacine Together? You should never take clonidine and guanfacine together. Both of these medications slow your heart rate, so taking them together can cause such a slow heart rate that you face dangerous or life-threatening consequences. You should only take one or the other, and one can’t be replaced with the other. If you want to change your medication, talk to your healthcare provider. Discuss available treatments for ADHD and anxiety with a qualified healthcare provider. [ ** Book an appointment ](https://join.medvidi.com/signup) ## What to Know Before Taking Clonidine or Guanfacine Both are hypotensive medications, which means they lower blood pressure. If you have a history of low blood pressure, then they may not be right for you. Some of the more serious warnings and adverse effects that can come along include: - Excessive drowsiness - Fainting - Low blood pressure or heart rate - Allergic reactions In addition, if you stop taking guanfacine or clonidine suddenly, it can lead to rebound hypertension, or a spike in your blood pressure. Never stop taking these medications without your healthcare provider’s approval. ## Is Guanfacine or Clonidine Right for You? Guanfacine and clonidine could both be good options to help you manage your ADHD and anxiety symptoms, especially if stimulant medications haven’t worked for you. Talk to your healthcare provider about these medications to learn what treatment is the most suitable for you. The [ADHD providers at MEDvidi](https://join.medvidi.com/signup) can recommend the right option for you based on your symptoms and medical history. ## FAQ ### Why is guanfacine not given to adults? Many physicians prescribe Intuniv off-label to treat adult ADHD and anxiety. Extended-release guanfacine (Intuniv) isn’t yet FDA-approved to treat ADHD in adults because there’s no research that says it’s effective. There are also more [ADHD medication options for adults](https://medvidi.com/adhd/medications/) that are effective. But its immediate-release form (Tenex) is approved for adults with high blood pressure. ### Does guanfacine calm you down? Guanfacine does have a sedating effect, which may help you feel drowsier and/or calmer. It also reduces blood pressure, which can help reduce the feeling of anxiety. ### Is guanfacine or clonidine better for sleep? Clonidine comes with some unpleasant side effects for sleep, including nightmares and sleep terrors. If you struggle with sleep already, then guanfacine may be a better choice for you. ### Does clonidine work immediately for ADHD? You may start to feel the sedating effects of clonidine within hours of taking it. However, to see the full effects for ADHD, it may take up to 8 weeks. ### Can I switch from clonidine to guanfacine? It’s possible to switch from clonidine to guanfacine, but not on your own. Under the supervision of a healthcare provider, you can slowly taper down on clonidine and start guanfacine. Stopping clonidine or guanfacine suddenly is dangerous and can lead to rebound hypertension (a sudden spike in blood pressure). ### Is guanfacine or clonidine more sedating? Both medications have sedating effects, but some research suggests that clonidine may be more sedating. ### Is clonidine or guanfacine better for tics? Both clonidine and guanfacine are used off-label to treat tic disorder. Research hasn’t found that one is necessarily more effective than the other.