Intuvin: A new ADHD medication

Intuvin is a new medication for ADHD, that is being marketed by Shire. Intuvin is an extended release guanfacine. Guanfacine is an anti-hypertensive agent. Shire is touting the benefits of Intuvin and appears to be placing particular emphasis on the fact that it is a non-stimulant and also is offered in extended release form.* However, there are several important things to keep in mind when considering a new ADHD medication such as Intuvin:

1. Limited data on the benefits of Intuvin

The benefits of Intuvin were established based on only two studies (ref. 1), that lasted 8 and 9 weeks respectively.

These studies compared the benefits of Intuvin to placebo. While Intuvin was found to be far more effective than a placebo in reducing ADHD symptoms there is no evidence that Intuvin is more or less effective than other ADHD medications.

There have been other studies of guanfacine (Tenex) in non-extended release form. Three out of four of these studies showed some improvement in ADHD symptoms. However, three of these studies were on small samples (under 20 subjects) and had no control groups. The one study using a control group found benefits for guanfacine relative to placebo (ref. 2.). However, these studies only support the claim that guanfacine is more effective than placebo.

2. How Intuvin (guanfacine) is supposed to work

As Shire notes on their website it is not certain how Intuvin works. The theoretical model suggests that it should increase receptiveness to Norepinephrine in the prefrontal cortext. Coincidently, this is the same neurotransmitter that Strattera (atomoxetine) is hypothesized to increase (albeit in a different manner (ref. 2).

3. Intuvin versus stimulant medications versus Strattera

There is no evidenced that Intuvin is more effective, or even as effective as other ADHD medications. The leading experts on ADHD all recommend that stimulant medication (no one stimulant has shown to be more effective than any other stimulant) be the initial medication of choice for persons with ADHD. Strattera (atomoxetine) is recommended as the second medication treatment option (ref. 4). Until more data is available on Intuvin recommending Intuvin as the medication of choice for ADHD would appear to be questionable.
A similar phenomena occurred several years ago, when Strattera hit the market. However, several studies have suggested that stimulants appear more effective than Strattera (ref. 5). Thus, the recommendation that stimulant medication be the first option in treating ADHD, appears to hold.

References
*Information about Intuvin can be viewed on www.intuvin.com.

Ref. 1. Biederman J, Melmed RD, Patel A, et al. A randomized, double-blind, placebo-controlled study of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder, Pediatrics, 2008; 121:e73-e84.

Ref. 2. Connor, D. “Other Medications,” in Barkley R. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 3rd ed. Guilford Press, New York, 2006, pp. 666-668.

Ref. 3. Prince J, Wilens T, Spencer T, & Biederman J. “Pharmacotherapy of ADHD in Adults,” in Barkley R. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 3rd ed d. Guilford Press, New York, 2006, p. 717.

Ref. 4. Barkley R, What is the role of Atomoxetine in the Management of ADHD, ADHD Report, April 2009.

Ref. 5. ADHD Report, October 2007, p. 14-15