Strattera vs. Intuniv for Childhood ADHD: 7 Notable Differences
Key takeaways:
Strattera (atomoxetine) and Intuniv (guanfacine ER) are oral medications that treat childhood attention-deficit hyperactivity disorder (ADHD). They’re both nonstimulants, but they work differently.
Intuniv is FDA approved for children ages 6 to 17, while Strattera is approved to treat both children and adults. Unlike Intuniv, Strattera has a boxed warning due to the potential risk of suicidal thoughts in children and adolescents.
The two medications also have different dosage recommendations and potential drug interactions. Talk to a pediatrician about the best ADHD treatment for your child.
Access savings on related medications
Table of contents
Learning that your child has attention-deficit hyperactivity disorder (ADHD) can feel overwhelming. But researchers have learned a lot about childhood ADHD over the last few decades. And there are now many options for treating ADHD in children. These options include behavioral therapy, physical activity, and interventions at school, such as setting clear classroom rules.
When needed, these behavioral and lifestyle-based treatments can also be combined with medication. And this dual approach can lead to better ADHD management overall.
Stimulants — like Adderall (amphetamine salts) and Ritalin (methylphenidate) — are first-choice ADHD medications. While stimulants are generally the most effective options, they aren’t the only ones. If your child can’t take stimulants or doesn’t find them effective, the next step may be trying a nonstimulant.
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There are many nonstimulants available for childhood ADHD. Two popular options are Strattera (atomoxetine) and Intuniv (guanfacine ER). Below, we look at seven notable differences between these medications.
1. Strattera and Intuniv are both nonstimulants, but they work differently
Between Strattera and Intuniv, experts generally recommend trying Strattera first. Though, this may not be the case for your child, depending on their symptoms and their prescriber’s expertise.
Strattera is a selective norepinephrine reuptake inhibitor (NRI). That means it keeps norepinephrine, a chemical messenger, around longer in the brain. Strattera is thought to treat ADHD by increasing norepinephrine levels. It also boosts dopamine, another chemical messenger, which may help with attention and concentration.
Intuniv works differently. It’s a central alpha-2 adrenergic receptor agonist. And it’s thought to improve attention and reduce hyperactivity by stimulating alpha-2 receptors (chemical binding sites) in the brain.
2. Intuniv’s active ingredient can treat high blood pressure
Intuniv’s active ingredient is guanfacine extended-release (ER), which is approved to treat ADHD. But guanfacine also comes in an immediate-release (IR) formulation. This version is approved to treat high blood pressure. Though, it’s typically only prescribed when other blood pressure medications aren’t effective.
Guanfacine IR can treat high blood pressure because alpha-2 adrenergic receptors are found throughout the nervous system. When the medication stimulates these receptors, it suppresses the part of the nervous system that’s responsible for the fight-or-flight response. This leads to a drop in blood pressure and heart rate.
ADHD symptoms in kids: Do you suspect that your child has attention-deficit hyperactivity disorder (ADHD)? Read more about possible symptoms to look out for.
Want advice on managing ADHD? Here are some firsthand tips from someone who lives with the condition.
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Strattera does not have this same mechanism or indication.
3. Strattera can also be prescribed to adults
Strattera and Intuniv are both approved to treat ADHD in children ages 6 to 17. But Strattera is also approved to treat ADHD in adults.
Most adults typically try a stimulant medication, such as Adderall or Ritalin, first. But if a stimulant isn’t effective or causes bothersome side effects, a nonstimulant like Strattera is a good option.
Keep in mind: Stimulants are controlled substances. This means they have a potential for dependence and misuse. If you can’t or don’t want to take a stimulant for this reason, Strattera may be a better choice.
4. Strattera and Intuniv have different recommended dosages
In addition to having different recommended dosages, Strattera and Intuniv are taken in unique ways.
Strattera is usually taken once in the morning, with or without food. But you also have the option to take it in two divided doses (once in the morning and once in the evening).
It’s best to take Intuniv with a full glass of water. While it can also be taken without food, you should avoid taking it with a high-fat meal. Eating a meal with a large amount of fat can cause higher levels of the medication than intended.
Below, we review the medications’ distinct recommended dosages.
Strattera dosages
Strattera comes as an oral capsule that’s taken once or twice a day.
Adults, in addition to children weighing over 70 kg (154 lbs), typically start with a daily dose of 40 mg. After a few days, a prescriber may adjust this starting dosage to a target dosage of 80 mg per day.
For children who weigh less than 70 kg, the recommended dosage depends on body weight. A typical starting dosage is 0.5 mg per kg daily. After 3 days, a prescriber may adjust this dosage to a target dosage of 1.2 mg per kg daily.
Weight-based dosages can be hard to visualize. As an example, a child who weighs 50 kg might start with 25 mg per day. Then, their dosage may be adjusted over time to a maximum of 60 mg per day.
Intuniv dosages
Intuniv comes as a tablet that’s taken by mouth once a day. It’s recommended to take it around the same time each day.
The starting Intuniv dosage is usually 1 mg per day. Your child’s prescriber may increase this starting dosage on a weekly basis to find a dosage that’s effective for your child. This is usually between 2 mg and 4 mg per day for children ages 6 to 12. Teenagers between the ages of 13 and 17 may take up to 7 mg per day. Body weight may impact your child’s dosage.
5. Each medication is backed by effectiveness data
Strattera and Intuniv haven’t been directly compared for their effectiveness in children. So it’s hard to say for sure if one is more effective than the other. However, they’ve each been evaluated in separate clinical studies.
Overall, the evidence for taking Strattera is generally stronger than Intuniv. In fact, Strattera is considered to be the most effective nonstimulant ADHD medication by experts.
However, Intuniv is approved for use with a stimulant as part of combination therapy, while Strattera isn’t. Also keep in mind that Intuniv is more effective for children ages 6 to 12 years old than it is for teenagers.
6. While both medications can cause side effects, Strattera is the only one with a boxed warning
Strattera and Intuniv can both cause side effects, such as sleepiness or fatigue, nausea, and dizziness. As mentioned, Intuniv’s active ingredient can also have an effect on blood pressure, so your child’s pediatrician may monitor their blood pressure regularly. It can also affect the heart’s conduction pattern.
But unlike Intuniv, Strattera carries a boxed warning (the FDA’s most serious medication warning). This warning states that Strattera can potentially raise the risk of suicidal thoughts among children and adolescents. Because of this, all kids taking Strattera should be closely observed for changes in behavior. This is especially important when first starting the medication or changing dosages.
While rare, Strattera has also been linked to certain liver and heart problems. So healthcare professionals may use caution when prescribing Strattera to people who have a history of these health conditions.
7. Strattera and Intuniv have unique drug interactions
Strattera and Intuniv are broken down by different types of liver proteins called cytochrome (CYP) P450 enzymes. If other medications disrupt these enzymes, it may impact the breakdown of Strattera or Intuniv, affecting its safety or effectiveness.
More specifically, Intuniv can interact with medications that disrupt the CYP3A4 enzyme. This includes ketoconazole, fluconazole, and rifampin, among others. Strattera can interact with medications that interfere with the CYP2D6 enzyme. Two examples are paroxetine and fluoxetine.
Strattera can also interact with other medications that affect heart rate and blood pressure, such as albuterol, and monoamine oxidase inhibitors (MAOIs). It’s recommended to completely avoid MAOIs, including rasagiline (Azilect) and selegiline (Eldepryl, Zelapar), while taking Strattera.
Make sure your prescriber and pharmacist have access to a full list of medications and supplements that you take, so they can help you manage or avoid potential interactions.
There are ways to save on Strattera and Intuniv
Strattera and Intuniv are both available as brand-name medications and lower-cost generics. Whichever medication you take, GoodRx can help you navigate ways to save on your prescription. GoodRx can help you save over 90% off the average retail price of the generic version of Strattera or Intuniv.
Generic Strattera’s price at certain pharmacies may be as low as $22.50 with a free GoodRx coupon. And generic Intuniv’s price at certain pharmacies may be as low as $17.83 with a free GoodRx coupon.
The bottom line
Strattera (atomoxetine) and Intuniv (guanfacine ER) are nonstimulant medications that are used to treat ADHD in children ages 6 and older. But Strattera is also approved for use in adults. And the medications work differently, have separate side effects, and are linked to distinct drug interactions.
Talk to a pediatrician about whether one of these nonstimulant options may be right for your child.
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References
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Neuchat, E. E., et al. (2023). The role of alpha-2 agonists for attention deficit hyperactivity disorder in children: A review. Neurology International.
Takeda Pharmaceuticals America, Inc. (2022). Intuniv - guanfacine tablet, extended release.
Tresco, K. E., et al. (2010). Psychosocial interventions to improve the school performance of students with attention-deficit/hyperactivity disorder. Mind Brain.
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