Compare ADHD medicines
Atomoxetine vs guanfacine: which differences matter?
Atomoxetine and guanfacine are non-stimulant ADHD medicines, but one cannot simply be swapped for the other. They differ in adult licensing, side effects and stopping instructions. Both need a planned trial and regular review.
Written and clinically reviewed by Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
Last updated: Last reviewed: Next review:Key points
- Both are non-stimulants, but one cannot simply be swapped for the other.
- Atomoxetine is licensed for adults; guanfacine’s licence covers ages 6 to 17.
- Atomoxetine can increase pulse and blood pressure; guanfacine can lower them.
- Guanfacine must be reduced gradually, with pulse and blood-pressure monitoring.
How do atomoxetine and guanfacine compare?
| Feature | Atomoxetine | Guanfacine prolonged-release |
|---|---|---|
| UK ADHD licence | Children aged six and over, adolescents and adults, subject to the product indication | Children and young people aged 6 to 17 when stimulants are unsuitable, not tolerated or ineffective |
| Adult treatment | Established option in NICE’s adult pathway | Off-label; tertiary ADHD service advice is required by NICE |
| Benefit | Develops gradually with regular treatment | Assessed over weeks during dose adjustment |
| Pulse and blood pressure | Can increase them | Can lower them |
| Sleep | Can cause sleepiness or insomnia | Sleepiness is a prominent possible effect |
| Stopping | Plan with the prescriber; different advice from guanfacine | Must be reduced gradually with pulse and blood-pressure monitoring |
Sources: Atomoxetine: Summary of Product Characteristics; Intuniv (guanfacine): Summary of Product Characteristics; NICE guideline NG87: medication choice (recommendations 1.7.7 to 1.7.22).
How long should I wait for improvement?
Neither medicine should be judged like a single dose of a short-acting stimulant. Your prescriber will consider the dose reached, time on treatment, useful changes and side effects.
Keep brief weekly notes. Do not wait through severe or worsening problems just because benefit may take time.
Which side effects need particular attention?
With atomoxetine, yellow skin or eyes, dark urine or upper-right tummy pain need urgent medical advice. Follow the guide’s specific liver-warning instructions.
With guanfacine, report troublesome sleepiness, dizziness or fainting promptly. Do not try to correct these by skipping doses or suddenly stopping treatment.
Sources: Atomoxetine: Summary of Product Characteristics; Intuniv (guanfacine): Summary of Product Characteristics.
How are missed doses and stopping different?
Guanfacine must not be stopped suddenly. If two or more consecutive doses are missed, contact the prescriber before restarting.
Atomoxetine also needs a treatment plan, but it does not have guanfacine’s same rebound blood-pressure warning. Follow its own leaflet and your prescriber’s instructions.
Sources: Intuniv (guanfacine): Summary of Product Characteristics; Atomoxetine: Summary of Product Characteristics.
Common questions
Is guanfacine a routine alternative for adults?
No. Its UK ADHD licence covers ages 6 to 17. Adult use needs specialist consideration and advice from a tertiary ADHD service.
Is atomoxetine better if sleep is a problem?
It may suit some people, but it can also cause insomnia or sleepiness. Your existing sleep pattern and response during treatment matter.
Can I change between them without a plan?
No. There is no direct dose conversion, and guanfacine needs particular care when reducing or restarting it.
Sources
This page is written for educational purposes and does not constitute medical advice. Always follow the guidance of your prescriber or pharmacist. If you have concerns about your medication, contact your clinical team.
About this page
- Written and clinically reviewed by
- Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
- First published
- Last updated
- Last reviewed
- Next review
“Last updated” is when the content last changed. “Last reviewed” is when it was last checked against current sources.
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