Skip to the answer

Guanfacine

Guanfacine is a blood-pressure-lowering medication used as an immediate-release tablet to treat high blood pressure, and as an extended-release tablet to treat ADHD (Attention Deficit Hyperactivity Disorder) in children and adolescents.

Brand names IntunivTenex
Drug classes Adrenergic Alpha2-agonists
Rx Forms 2
Dr. Brian Staiger, PharmD, BCPS
Reviewed by Last reviewed Jul 10, 2026 Content updated Oct 2, 2026
🧬 Where this information comes from Click to expand

The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 64 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →

✓No current FDA shortage listed · checked Oct 5, 2026
Guanfacine at a glance The quick version — the full detail is in the Patient Information Guide below.
Dr. Brian Staiger, PharmD, BCPS
The Pharmacist’s Take By · Clinical pharmacist · Written

Guanfacine, on the market since about 1995 and available as a generic, activates alpha-2A receptors in the brain, calming signals that drive up heart rate and blood pressure; the immediate-release tablet treats high blood pressure, and the extended-release form (Intuniv) treats ADHD in ages 6 to 17, usually as a second-line non-stimulant option or an add-on to a stimulant. Most people tolerate it fairly well, but drowsiness and tiredness are common, especially early on, and dizziness when standing reflects lower blood pressure and heart rate. Never stop it abruptly, since that can trigger a dangerous rebound spike in blood pressure; stopping should be a slow taper your prescriber plans.

Clinical pearls

  • Swallow extended-release tablets whole, and avoid taking them with a high-fat meal, which sharply increases how much drug is absorbed.
  • If a child vomits and misses doses, call the prescriber, since a short gap can set off rebound high blood pressure.
  • Fluconazole, ketoconazole and similar liver-enzyme blockers raise guanfacine levels, while rifampin and efavirenz lower them.
  • Avoid alcohol, and be wary of sleep aids and other sedatives, which pile onto guanfacine's drowsiness.
How we write & review this content — our editorial policy →
How you get itPrescription only
Comes asExtended-release tablet, Tablet
Earliest FDA record1986
Companies listing it with the FDA34
FDA label last updatedJun 23, 2025
FDA’s strongest warning (boxed)None on the label

Patient information guide A plain-language walkthrough of Guanfacine, written from its FDA label.

What Guanfacine is used for

▾

Guanfacine is available in two formulations that are approved for different conditions:

  • High blood pressure (hypertension): Guanfacine immediate-release tablets (Guanfacine, Guanfacine Hydrochloride) are used to lower blood pressure. They can be used alone or alongside other antihypertensive (blood pressure–lowering) medicines, especially thiazide diuretics.
  • ADHD in children and adolescents (ages 6–17): Guanfacine extended-release tablets — including Intuniv, Guanfacine ER, and Guanfacine extended-release — are approved to treat Attention Deficit Hyperactivity Disorder. They can be used on their own or as add-on therapy with a stimulant ADHD medication.

How Guanfacine works

▾

Guanfacine is a selective alpha-2A adrenergic receptor agonist — it attaches to and activates specific receptors in the brain. This dampens the nerve signals that normally tell the heart to beat faster and blood vessels to constrict, resulting in lower blood pressure and a slower heart rate. Guanfacine is not a stimulant and works through a completely different pathway than medications like amphetamines. While its blood-pressure-lowering effect is well understood, the exact reason it helps with ADHD symptoms is not yet known.

Guanfacine dosage

▾

How guanfacine is taken depends on the formulation:

  • Immediate-release tablets (for high blood pressure): taken once daily by mouth, usually at bedtime. They may be taken with or without food.
  • Extended-release tablets (for ADHD — Intuniv, Guanfacine ER, Guanfacine extended-release): taken once daily, either morning or evening, at the same time each day. Swallow whole — never crush, chew, or break. Avoid high-fat meals when taking the extended-release form. If you need to stop, the dose should be reduced gradually over time to avoid a rebound rise in blood pressure.

Never switch between the immediate-release and extended-release forms at the same dose without your doctor's guidance — they are absorbed differently and are not interchangeable milligram for milligram.

Dosing details from the FDA-approved label

From the Guanfacine prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.

  • Recommended dose (guanfacine extended-release; ADHD per label context)
    • 1 mg to 7 mg (0.05 to 0.12 mg/kg target weight based dose range) once daily in the morning or evening based on clinical response and tolerability
    • Begin at 1 mg/day and adjust in increments of no more than 1 mg/week
    • Maximum: Doses above 4 mg/day have not been evaluated in children (ages 6 to 12 years) and doses above 7 mg/day have not been evaluated in adolescents (ages 13 to 17 years)
    • Swallow whole; do not crush, chew or break; do not administer with high fat meals
  • Weight 25 to 33.9 kg
    • 2 to 3 mg/day
    • Target dose range 0.05 to 0.12 mg/kg/day
  • Weight 34 to 41.4 kg
    • 2 to 4 mg/day
    • Target dose range 0.05 to 0.12 mg/kg/day
  • Weight 41.5 to 49.4 kg
    • 3 to 5 mg/day
    • Target dose range 0.05 to 0.12 mg/kg/day
  • Weight 49.5 to 58.4 kg
    • 3 to 6 mg/day
    • Target dose range 0.05 to 0.12 mg/kg/day
  • Weight 58.5 to 91 kg
    • 4 to 7 mg/day
    • Target dose range 0.05 to 0.12 mg/kg/day
  • Weight >91 kg
    • 5 to 7 mg/day
    • Target dose range 0.05 to 0.12 mg/kg/day
  • Switching from immediate-release guanfacine
    • Discontinue immediate-release treatment and titrate with guanfacine extended-release tablets following the recommended schedule
    • Do not substitute on a milligram-per-milligram basis because of differing pharmacokinetic profiles
  • Discontinuation of treatment
    • Taper the daily dose in decrements of no more than 1 mg every 3 to 7 days
    • To minimize the risk of rebound hypertension; monitor blood pressure and pulse
  • Missed doses
    • After two or more missed consecutive doses, consider titration based on patient tolerability when reinitiating the previous maintenance dose
Read the label’s full dosing text

2 DOSAGE AND ADMINISTRATION • Recommended dose: 1 mg to 7 mg (0.05-0.12 mg/kg target weight based dose range) once daily in the morning or evening based on clinical response and tolerability ( 2.2 ) . • Begin at a dose of 1 mg once daily and adjust in increments of no more than 1 mg/week ( 2.2 ) . • Do not crush, chew or break tablets before swallowing ( 2.1 ) . • Do not administer with high-fat meals, because of increased exposure ( 2.1 ) . • Do not substitute for immediate-release guanfacine tablets on a mg-per-mg basis, because of differing pharmacokinetic profiles ( 2.3 ) . • If switching from immediate-release guanfacine, discontinue that treatment and titrate with guanfacine extended-release tablets as directed ( 2.3 ) . • When discontinuing, taper the dose in decrements of no more than 1 mg every 3 to 7 days to avoid rebound hypertension ( 2.5 ) . 2.1 General Instruction for Use Swallow tablets whole. Do not crush, chew, or break tablets because this will increase the rate of guanfacine release. Do not administer with high fat meals, due to increased exposure. 2.2 Dose Selection Take guanfacine extended-release tablets orally once daily, either in the morning or evening, at approximately the same time each day. Begin at a dose of 1 mg/day, and adjust in increments of no more than 1 mg/week. In monotherapy clinical trials, there was dose- and exposure-related clinical improvement as well as risks for several clinically significant adverse reactions (hypotension, bradycardia, sedative events). To balance the exposure-related potential benefits and risks, the recommended target dose range depending on clinical response and tolerability for guanfacine extended-release tablets is 0.05 to 0.12 mg/kg/day (total daily dose between 1 to 7 mg) (See Table 1 ).

Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →

Guanfacine side effects

▾

The most commonly reported side effects with guanfacine extended-release include:

Common side effects

  • Drowsiness or sleepiness (somnolence)
  • Fatigue or low energy
  • Low blood pressure (hypotension)
  • Dizziness
  • Nausea or stomach pain
  • Dry mouth
  • Headache
  • Slow heart rate (bradycardia)
  • Difficulty sleeping (insomnia)
  • Decreased appetite

When to get medical help

  • Call your doctor if you feel faint, lightheaded, or actually pass out — this may be a sign of dangerously low blood pressure or slow heart rate
  • Seek help if you feel extreme drowsiness that is unusual or interfering with daily function
  • Do not stop guanfacine suddenly — this can cause a sharp rebound rise in blood pressure; taper under your doctor's guidance
  • Contact your doctor if you notice signs of irregular heartbeat or heart conduction problems, especially if you take other heart-affecting medicines
  • If you miss doses due to vomiting (common in children), contact your prescriber — abrupt interruption can cause rebound high blood pressure

Serious reactions to watch for include significant drops in blood pressure, fainting (syncope), very slow heart rate, and — if guanfacine is stopped suddenly — a dangerous rebound spike in blood pressure. Contact your doctor promptly if you experience any of these.

Guanfacine warnings and precautions

▾
  • Low blood pressure, slow heart rate, and fainting: Guanfacine can cause dose-related drops in blood pressure and heart rate. Risk is higher in people who are dehydrated, have heart conditions, or take other medicines that lower blood pressure. Blood pressure and heart rate should be monitored regularly.
  • Drowsiness: Sedation is one of the most common effects. Do not drive or operate heavy machinery until you know how guanfacine affects you. Avoid alcohol and be cautious with any other sedating medicines.
  • Heart conduction problems: Guanfacine may worsen problems with the heart's electrical system (such as AV block or sinus node dysfunction), especially when combined with other sympatholytic (nerve-calming) drugs.
  • Rebound hypertension on stopping: Stopping abruptly — particularly at higher doses or when also taking a stimulant — can cause blood pressure to spike well above where it started. In serious cases, this has led to hypertensive encephalopathy. Always taper the dose gradually under medical supervision.

Guanfacine interactions

▾

Several medications and substances can meaningfully affect how guanfacine works or increase the risk of side effects:

  • Strong/moderate CYP3A4 inhibitors (e.g., ketoconazole, fluconazole): block the enzyme that breaks down guanfacine, raising its blood levels — a dose reduction is usually needed
  • Strong/moderate CYP3A4 inducers (e.g., rifampin, efavirenz): speed up guanfacine metabolism, lowering its blood levels — a dose increase may be needed
  • Other antihypertensives or heart-rate-slowing drugs: combined use can cause an additive drop in blood pressure or heart rate
  • CNS depressants (sedatives, sleep aids, anxiety medicines): can worsen drowsiness when taken with guanfacine
  • Alcohol: increases sedation — avoid while taking guanfacine
  • OCT1 substrate drugs: guanfacine inhibits this transporter and may raise blood levels of drugs that use it

Interactions listed in the FDA-approved label

From the Guanfacine prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.

  • Strong and moderate CYP3A4 inhibitors (e.g., ketoconazole, fluconazole): Guanfacine is primarily metabolized by CYP3A4 and these inhibitors increase guanfacine exposure. Consider dose reduction; decrease guanfacine extended-release to 50% of target dosage (half the recommended level)
  • Strong and moderate CYP3A4 inducers (e.g., rifampin, efavirenz): Guanfacine is primarily metabolized by CYP3A4 and these inducers decrease guanfacine exposure. Consider dose increase; based on patient response, consider titrating up to double the target dosage over 1 to 2 weeks
Read the label’s full interactions text

7 DRUG INTERACTIONS Table 14 contains clinically important drug interactions with guanfacine extended-release [see Clinical Pharmacology ( 12.3 )] . Table 14: Clinically Important Drug Interactions: Effect of other Drugs on Guanfacine Extended-Release Concomitant Drug Name or Drug Class Clinical Rationale and Magnitude of Drug Interaction Clinical Recommendation Strong and moderate CYP3A4 inhibitors, e.g., ketoconazole, fluconazole Guanfacine is primarily metabolized by CYP3A4 and its plasma concentrations can be significantly affected resulting in an increase in exposure Consider dose reduction [see Dosage and administration ( 2.7 )] Strong and moderate CYP3A4 inducers, e.g., rifampin, efavirenz Guanfacine is primarily metabolized by CYP3A4 and its plasma concentrations can be significantly affected resulting in a decrease in exposure Consider dose increase [see Dosage and administration ( 2.7 )] Strong and moderate CYP3A4 inhibitors increase guanfacine exposure. Decrease guanfacine extended-release to 50% of target dosage when coadministered with strong and moderate CYP3A4 inhibitors ( 2.7 ). Strong and moderate CYP3A4 inducers decrease guanfacine exposure. Based on patient response, consider titrating guanfacine extended-release dosage up to double the target dosage over 1 to 2 weeks ( 2.7 ). Additional pediatric use information for patients ages 6 to 17 years is approved for Shire US Inc.’s INTUNIV ® (guanfacine) extended- release tablet product. However, due to Shire US Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.

Read the full Drug Interactions section on DailyMed →

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

🌿136 supplements and herbs with documented Guanfacine interactions, ranked by severity Check Guanfacine against a supplement or herb →

Before taking Guanfacine

▾
  • Do not take guanfacine if you have had a serious allergic reaction (such as rash or severe itching) to guanfacine or any product containing it
  • Tell your doctor if you have low blood pressure, slow heart rate, heart block, or any heart, blood vessel, or cerebrovascular (brain blood vessel) condition
  • Tell your doctor if you have kidney disease — guanfacine clearance decreases as kidney function declines, and a dose adjustment may be needed
  • Tell your doctor if you have liver disease — roughly half of guanfacine is cleared by the liver, and impairment can affect drug levels
  • Tell your doctor if you have a history of fainting or conditions that make you prone to fainting (such as dehydration or orthostatic hypotension)
  • Pregnancy: Decades of use have not identified a clear drug-associated risk to the baby, but data are limited. A pregnancy registry is available (call 1-866-961-2388). Discuss the benefits and risks with your doctor.
  • Breastfeeding: It is not known if guanfacine passes into human milk. Animal data suggest it likely does. Monitor a nursing infant for sedation, poor feeding, or lethargy, and discuss with your doctor.
  • Children under 6: Safety and effectiveness of guanfacine extended-release have not been established in children younger than 6
  • Older adults: Safety and effectiveness of guanfacine extended-release have not been established in elderly patients

Guanfacine overdose

▾

Taking too much guanfacine can cause low blood pressure, very slow heart rate, extreme drowsiness, and lethargy. An initial brief rise in blood pressure may occur first, followed by a drop. Children who become very sleepy after an overdose should be watched closely for up to 24 hours, as worsening effects (including coma) can develop with a delay.

If an overdose is suspected, call Poison Control immediately at 1-800-222-1222 or go to the nearest emergency room.

What Guanfacine does in the body

▾

Guanfacine selectively activates alpha-2A adrenergic receptors in the brain — it binds to these receptors 15 to 20 times more strongly than to related receptor subtypes (alpha-2B and alpha-2C). This action reduces nerve signals from the brain's blood-pressure control center to the heart and blood vessels, leading to lower resistance in the arteries and a slower heart rate. At the doses used clinically, guanfacine does not meaningfully prolong the QTc interval (an electrical measurement of the heart's rhythm).

How your body processes Guanfacine

▾

Guanfacine is readily absorbed after oral dosing and is about 70% bound to proteins in the blood. The extended-release form reaches peak blood levels around 5–6 hours after a dose, compared to about 3 hours for the immediate-release tablet. The two forms deliver different amounts of drug to the body and cannot be swapped at the same milligram dose. Guanfacine is primarily broken down by a liver enzyme called CYP3A4, and the body clears it through both the liver and kidneys, with a half-life (time for the body to eliminate half the drug) of roughly 16–18 hours. Eating a high-fat meal with the extended-release form significantly increases drug absorption. Children tend to have higher drug levels than adolescents and adults at the same dose, likely due to lower body weight.

How to store Guanfacine

▾

Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) .

Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →

136

Supplements & herbs that interact with Guanfacine

136 supplements and herbal products have documented interactions with Guanfacine in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.

Severity mix
  • Major · 4
  • Moderate · 111
  • Minor · 21
ACTIVATED CHARCOAL Major AMERICAN HELLEBORE Major AMERICAN MISTLETOE Major TYRAMINE Major ADRAFINIL Moderate AGMATINE Moderate ALGAL OIL Moderate ANDROGRAPHIS Moderate +128 more
Every supplement checked against Guanfacine — ranked by severity The full interaction hub: 4 major · 111 moderate · 21 minor · every one linked to its full report. Check Guanfacine against your exact supplements

Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.

1

Nutrient depletion considerations

Guanfacine has been associated with lower levels of 1 nutrient in the clinical literature. This does not mean a deficiency will occur — it means these may be worth discussing with your pharmacist or healthcare provider, especially with long-term use.

COENZYME Q10 Insufficient Evidence
See the full Guanfacine nutrient depletion report

Educational information from a licensed clinical database (Natural Medicines) — not medical advice. Do not start or stop medications or supplements without professional guidance.

Guanfacine: pharmacist answers to common questions

Quick, plain-English answers to the questions patients ask most about Guanfacine — the kind of thing our pharmacy team would talk through with you at the counter.

What is guanfacine actually used for — is it for ADHD or blood pressure?

▾
It's used for both, depending on which form you have. The regular (immediate-release) tablet is prescribed for high blood pressure. The extended-release version — brand name Intuniv, also available as a generic — is approved for ADHD in children and adolescents ages 6 to 17. It can be used alone for ADHD or added on to a stimulant medication. Make sure you know which form you've been prescribed and why.

My child takes Intuniv for ADHD — is it a stimulant?

▾
No, Intuniv is not a stimulant at all. It works on a different part of the brain than medications like Adderall or Ritalin. That's actually one reason it's sometimes used alongside a stimulant — it works through a completely different pathway. The exact reason it helps ADHD symptoms isn't fully understood, but it's well-established that it's not a stimulant.

What side effects should I watch for most closely?

▾
Drowsiness is the most common one — it affects a lot of people, especially early in treatment. Low blood pressure (which can make you feel dizzy or lightheaded, especially when standing up) and a slow heart rate are also real concerns. These are usually manageable but worth watching. If your child seems extremely drowsy, faint, or has an unusually slow pulse, call your doctor. These effects tend to be related to the dose.

Can I just stop taking guanfacine if I decide to quit?

▾
Please don't stop it abruptly. Quitting guanfacine suddenly — especially at higher doses — can cause your blood pressure to rebound and spike above where it was before you started. In some cases this has been serious. Your doctor will give you a plan to slowly reduce the dose over a few weeks. This is especially important for children, who might accidentally miss doses if they're vomiting from an illness.

Can guanfacine be taken with other medications or alcohol?

▾
A few important ones to know about: certain antifungals like ketoconazole or fluconazole can raise guanfacine levels in your blood, while drugs like rifampin can lower them — both situations may need a dose adjustment. Anything that makes you drowsy (sleep aids, anxiety medicines) will add to guanfacine's sedating effect. Avoid alcohol for the same reason. Always tell your pharmacist and doctor everything you take, including over-the-counter products.

Is it safe to take during pregnancy or while breastfeeding?

▾
Decades of use haven't revealed a clear risk to the baby, but the data during pregnancy are limited. There's an official pregnancy registry you or your doctor can enroll in (call 1-866-961-2388) to help researchers track outcomes. For breastfeeding, we don't have data on whether guanfacine passes into human milk, but animal studies suggest it likely does. If you're nursing, watch your baby for unusual sleepiness, poor feeding, or lethargy — and keep your doctor in the loop.

Is Guanfacine available over the counter?

▾
No. Guanfacine is a prescription medicine: every Guanfacine product listed with the FDA is prescription only, so it is not sold over the counter. Your prescriber decides whether it is appropriate for you, and your pharmacist dispenses it.

When was Guanfacine first available?

▾
The earliest FDA record we hold for Guanfacine is from 1986: its first approval in Drugs@FDA or its earliest product listing in the NDC Directory, whichever is older. Many older medicines were in use before their first formal FDA approval, so this is the earliest date on record, not necessarily when Guanfacine was first used.

Who makes Guanfacine?

▾
34 companies currently list Guanfacine products in the FDA's NDC Directory, including Bryant Ranch Prepack, Golden State Medical Supply, Inc., Remedyrepack Inc.. That count includes repackagers and distributors as well as manufacturers (companies that sell only the raw ingredient are not counted), so fewer companies actually make it; the label on your bottle names the one that supplied yours.

Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →

More about Guanfacine on HelloPharmacist

📊Guanfacine supplement interactions136 checked — ranked by severity 🌿Drug & Supplement CheckerGuanfacine vs. vitamins & herbs 💬Ask a PharmacistFree answer, usually < 24h 🔎NDC & pricing lookupFind Guanfacine NDCs & costs 🅰️Browse Drugs A–ZLook up any medication
Detailed data & references for Guanfacine Forms & strengths, pricing, billing codes, manufacturers, safety reports and sourcing — the data behind the page. Most people can stop here. Each section below opens on a tap.

Guanfacine forms and strengths (how it comes)

Guanfacine is available in 2 forms. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.

Extended-release tablet

By mouth
Brands Intuniv
How this form is used
What it may be used for
  • Intuniv is approved to treat ADHD in children and adolescents (ages 6–17) as a standalone therapy
  • Intuniv is approved as add-on therapy to stimulant ADHD medications in children and adolescents
  • Guanfacine extended-release tablets are indicated for ADHD treatment as monotherapy or adjunctive therapy to stimulants
Important instructions
  • Swallow extended-release tablets whole — do not crush, chew, or break them, as this speeds up drug release
  • Take once daily at approximately the same time each day, either in the morning or evening
  • Do not take with a high-fat meal — it significantly increases the amount of drug your body absorbs
  • When stopping Intuniv or other guanfacine extended-release products, the dose must be tapered gradually — do not quit suddenly
Available strengths 4 strengths
1 mg 2 mg 3 mg 4 mg
172 FDA-listed product records ⓘ

Tablet

By mouth
How this form is used
What it may be used for
  • Guanfacine Hydrochloride tablets are used to manage high blood pressure (hypertension)
  • Guanfacine tablets may be used alone or combined with other blood pressure medicines, particularly thiazide-type diuretics
Important instructions
  • Guanfacine Hydrochloride tablets are taken once daily, typically at bedtime to minimize daytime drowsiness
  • Do not switch between immediate-release guanfacine tablets and extended-release tablets at the same milligram dose — the two forms are absorbed differently and are not interchangeable on a mg-per-mg basis
Available strengths 2 strengths
1 mg 2 mg
70 FDA-listed product records ⓘ

Guanfacine on the U.S. market: products, makers and brands

How Guanfacine appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.

34 companies list 117 Guanfacine product records with the FDA, mostly as extended-release tablet, tablet; the earliest marketing or approval year on record is 1986. Brand names on the directory include Intuniv, Tenex; the rest are generics.

2
Dose forms ⓘ
34
Labelers (makers, repackagers, distributors)
5
Brand names
117
FDA-listed product records ⓘ
1986
Earliest FDA record ⓘ

FDA-listed product records by dose form (tablet variants merged) — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

Also listed with the FDA, not a patient dose form: Powder (9) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.

Bryant Ranch Prepack9%
Golden State Medical Supply, Inc.7%
Remedyrepack Inc.7%
Actavis Pharma, Inc.5%
Northstar Rxllc5%
Unichem Pharmaceuticals (USA), Inc.5%
Other makers62%

Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

How widely Guanfacine is used (Medicaid data)

A general measure of how commonly Guanfacine is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.

Think of this as a proxy for how widely Guanfacine is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.

4,043,576
Medicaid prescriptions filled (Q1–Q4 2025)
$65.9M gross Medicaid reimbursement (before mandatory rebates — net cost is lower)

How commonly is Guanfacine prescribed? Of the 1,601 medications we measure, Guanfacine ranks #52 by Medicaid prescriptions — more than 97% of them.

Where Guanfacine ranks among the drugs we measure · Q1–Q4 2025 · neighbors ±5
Total prescriptions — #52 of 1,601
#47 Lamotrigine 4,467,083 Rx #48 Cyclobenzaprine 4,437,147 Rx #49 Triamcinolone Topical 4,329,207 Rx #50 Duloxetine 4,105,865 Rx #51 Methadone 4,056,849 Rx #52 Guanfacine 4,043,576 Rx #53 Lisdexamfetamine 3,941,773 Rx #54 Cephalexin 3,933,834 Rx #55 Rosuvastatin 3,856,155 Rx #56 Insulin Glargine (rDNA... 3,731,821 Rx #57 Clonazepam 3,602,972 Rx

Utilization by Guanfacine product

Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.

The 1 mg oral tablet is the most-dispensed Guanfacine product — about 24% of these Medicaid prescriptions.

guanfacine 1 MG Oral Tablet Most dispensed

975,856 Medicaid prescriptions (Q1–Q4 2025) 24% of Guanfacine prescriptions shown $16.4M gross reimbursement (before rebates) ≈ $17 per prescription (gross)

Summed across the 12 of 41 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197745

24 HR guanfacine 1 MG Extended Release Oral Tablet

953,492 Medicaid prescriptions (Q1–Q4 2025) 24% of Guanfacine prescriptions shown $14.3M gross reimbursement (before rebates) ≈ $15 per prescription (gross)

Summed across the 10 of 47 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 862006

24 HR guanfacine 2 MG Extended Release Oral Tablet

939,359 Medicaid prescriptions (Q1–Q4 2025) 23% of Guanfacine prescriptions shown $14.7M gross reimbursement (before rebates) ≈ $16 per prescription (gross)

Summed across the 11 of 47 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 862013

24 HR guanfacine 3 MG Extended Release Oral Tablet

521,947 Medicaid prescriptions (Q1–Q4 2025) 13% of Guanfacine prescriptions shown $7.9M gross reimbursement (before rebates) ≈ $15 per prescription (gross)

Summed across the 11 of 44 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 862019

24 HR guanfacine 4 MG Extended Release Oral Tablet

376,367 Medicaid prescriptions (Q1–Q4 2025) 9% of Guanfacine prescriptions shown $6.2M gross reimbursement (before rebates) ≈ $17 per prescription (gross)

Summed across the 10 of 40 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 862025

guanfacine 2 MG Oral Tablet

276,555 Medicaid prescriptions (Q1–Q4 2025) 7% of Guanfacine prescriptions shown $6.4M gross reimbursement (before rebates) ≈ $23 per prescription (gross)

Summed across the 11 of 30 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197746

Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.

Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Guanfacine, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 65 of 249 listed Guanfacine NDCs with Medicaid activity.

Compare Guanfacine products

A representative set of FDA-listed product records for Guanfacine — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)

Showing 105 of 117 products — FDA National Drug Code Directory. See every product, package size and price: browse all 117 Guanfacine NDCs →

Guanfacine recall history

A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.

The FDA’s enforcement reports list no Guanfacine recalls since July 2021.

✅No Guanfacine recalls on record since July 2021

Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.

RxNorm Concept Web — From Ingredient to Every Form and Strength

This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.

Ingredient (IN) Guanfacine RxCUI 40114 2 dose forms · 6 strengths
  2. Dose form (SCDF) Oral Tablet RxCUI 372368 In current FDA listings
    Clinical drug / strength (SCD) 1 MG RxCUI 197745 2 MG RxCUI 197746

Look up RxCUI 40114 in the RxCUI Atlas →

RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.

💵 What Guanfacine costs pharmacies (NADAC benchmark)

The national average invoice price pharmacies pay for the drug itself, from CMS's NADAC survey (data as of Sep 30, 2026). This is a supply-cost benchmark — not a retail price and not what you'd pay at the counter.

FormStrengthPharmacy acquisition benchmark
Tablet, Extended Release · Oral 1 mg $0.133 per tablet NDC details & price history
Tablet, Extended Release · Oral 2 mg $0.148 per tablet NDC details & price history
Tablet, Extended Release · Oral 3 mg $0.166 per tablet NDC details & price history
Tablet, Extended Release · Oral 4 mg $0.176 per tablet NDC details & price history
Tablet · Oral 1 mg $0.147 per tablet NDC details & price history
Tablet · Oral 2 mg $0.267 per tablet NDC details & price history
Tablet 2 mg $0.267 per tablet NDC details & price history
Tablet 1 mg $0.147 per tablet NDC details & price history
Why show this? Your out-of-pocket cost depends on insurance, pharmacy markup, and discounts — but the acquisition benchmark tells you whether the medication itself is inexpensive or costly, which strengths cost more per dose, and whether a cash-price quote is in a reasonable range. Each row links to the NDC-level record with its full price history.

Source: CMS National Average Drug Acquisition Cost (NADAC), a survey of retail pharmacy invoice prices. Benchmarks shown are the range across package sizes of a representative product for each form and strength — other manufacturers' products may differ.

Guanfacine brand names

Guanfacine is sold under 2 brand names in the FDA directory — Intuniv, Tenex. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.

Intuniv Tenex

Who makes Guanfacine: manufacturers and labelers

34 companies list Guanfacine products with the FDA. By number of product records, the largest are Bryant Ranch Prepack, Golden State Medical Supply, Inc., Remedyrepack Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.

Bryant Ranch Prepack 10 Golden State Medical Supply, Inc. 8 Remedyrepack Inc. 8 Actavis Pharma, Inc. 6 Northstar Rxllc 6 Unichem Pharmaceuticals (USA), Inc. 6 Proficient Rx LP 5 A-S Medication Solutions 4 Advagen Pharma Limited 4 Alembic Pharmaceuticals Inc. 4 Alembic Pharmaceuticals Limited 4 Apotex Corp. 4 Fosun Pharma USA, Inc 4 Slate Run Pharmaceuticals, LLC 4 Sun Pharmaceutical Industries, Inc 4 Takeda Pharmaceuticals America, Inc. 4 Upsher-Smith Laboratories, LLC 4 Advagen Pharma Ltd 2 Ajanta Pharma USA Inc. 2 Amneal Pharmaceuticals LLC 2 Amneal Pharmaceuticals of New York LLC 2 Aurobindo Pharma Limited 2 Chartwell RX, LLC 2 Coupler LLC 2

…and 10 more on the FDA NDC directory.

Guanfacine drug class (RxNorm)

Guanfacine belongs to the Central alpha-2 Adrenergic Agonist class.

Pharmacologic class Central alpha-2 Adrenergic Agonist
Drug family (ATC) Imidazoline receptor agonists
How it works Adrenergic alpha2-Agonists

Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.

Sources for this Guanfacine page

Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.

📄
FDA-filed drug labels (SPL) Uses, dosing, warnings & side effects from SPL records retrieved through openFDA; the linked representative set can be verified on DailyMed. ✓ Linked label effective Jun 23, 2025
🏭
Forms, brands & labelersAggregated from ingredient-matched FDA National Drug Code Directory product records for Guanfacine.
📈
Real-world reportsThe FDA Adverse Event Reporting System (FAERS), served through openFDA.
🚨
Recalls & shortagesopenFDA drug-enforcement reports and the FDA drug-shortage database.
🧾 Clinical label set — FDA-filed SPL labels retained for Guanfacine after exact ingredient or ingredient-combination matching and applicable route/form matching
Clinical labels in scope
64
Finished products in the current FDA directory
117
Companies listing them (makers, repackagers, distributors)
34
FDA labeler codes behind them ⓘ
38
Linked representative label ⓘ
Takeda Pharmaceuticals America, Inc.
Linked label effective
Jun 23, 2025
Composite sections available
25
Linked SPL Set ID
b972af81-3a37-40be-9fe1-3ddf59852528
Linked SPL Document ID
448b4d80-7441-4a2f-839f-c61052d6e83a
Open the linked representative label on DailyMed ↗

How this page is built

HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Takeda Pharmaceuticals America, Inc. is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →