Intuniv for Treating Tics and Twitches

Written by dad - 174 Comments

As I’ve noted in the past, our oldest son has a history of tics and twitches. In the past, these have come and gone, often associated with stressful periods in our lives, and never lasting more than a few months.

This past fall, our son (eleven years old at the time) started middle school, and shortly thereafter the tics returned. They’ve presented as eye blinking, nose wrinkling, and a funny little mouth stretch (for lack of a better term). While we kept hoping they’d go away, they haven’t.

We’re now pushing six months, our eleven year old has turned twelve, and there have been no signs of improvement. Since this is by far the longest he’s had them, we decided to have him checked out.

After evaluating him, the doctor recommended two possible pharmaceutical solutions. I should note here that, in addition to the tics, he’s rather high strung, and we’ve also been having some issues with his aggression toward his brothers.

Lexapro vs. Intuniv

The two options that we were given were Lexapro (escitalopram) and Intuniv (guanfacine; the time release version of Tenex). Lexapro is a selective serotonin reuptake inhibitor (SSRI) that is often prescribed as an anti-depressant. This would help with his anxiety, and could also reduce the incidence of his tics.

Intuniv, on the other hand, is an alpha-2-adrenergic agent that is often prescribed for ADHD, and is also thought to be effective in treating tics. After a good bit of research, as well as consultation with our family practitioner, we decided to go with the Intuniv.

He started on a 1mg/day dose for the first week, going up to 2mg/day this week, and 3mg/day next week. We’ll then take him back in to get checked out by the doctor. While we still haven’t seen an effect, we’re still ramping up to therapeutic levels. I’ll update when we know more.

Real-world side effects of Intuniv

While our son hasn’t been on Intuniv for very long, we have noticed some minor side effects. For example, he’s had a bit of an upset stomach and reduced appetite, especially since we increased the dosage to 2mg/day. He’s also been more tired than normal, and has been waking up at night and having trouble falling back asleep.

Published on January 28th, 2010 - 174 Comments
Filed under: Health
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  1. thank you, ryan, for writing back so quickly. everything is so individual, i am wondering how to synthesize all of this info. one common thing i see in the posts is that the beginning regimen of intuniv is successful, but later sort of turns badly and causes problems… scares me as my son will be back at school and he’ll be dealing on his own until he comes home for thanksgiving. it feels strange to me that he was prescribed this by a pediatrician and not a psych, but his symptoms and description to the doc were evidently so obvious and common that it seemed appropriate…..

    Comment by miriam — Oct 8th 2011 @ 9:18 pm
  2. My 12 yr old was just prescribed Respirdal for his ADHD symptons. Can anyone give me any experiences with this?

    Comment by Kristi — Oct 19th 2011 @ 3:28 am
  3. My son used Risperdal along with his stimulant meds but not by itself. Risperdal put a lot of weight on him (which was a big change from the meds that kept him skinny), but it’s been several years since he was on it, and he still has a tummy. Of course, he is a non-athletic 17 year old, so that could be part of his problems. However his dad and I were not very active as teens and we were abnormally skinny. I think he was prescribed it for anxiety and he has probably been off of it about 4 years. Online it says “Risperidone (the other name for it) is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5-16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). I think Nicholas took it from around age 9-14.

    Comment by Nancy — Oct 19th 2011 @ 3:46 am
  4. Hi, My daughter is 9 and has been diagnosed with ADHD and Anxiety. She was diagnosed with ADHD at 5 and just diagnosed at age 8 with Anxiety. She is taking Focalin XR 15mg and Prozac 10mg and tenex 1 mg at night. She was doing well at school (3rd grade) until a few weeks ago. She stated picking her fingers instead of working on her class work. She picks until they bleed and then pushing on her finger until she gets the blood out. It is effecting her learning because she is so focused on Picking. She get angry if she is told to stop picking hiting and kicking her teachers. She is now also getting very hyper at school and at home..laughing uncontrollably and doing things just to get attenetion.

    I have an appointment set up with a psychologist, but I am at a loss as to how to get her to stop picking her fingers. currently she is still on track at school but it takes alot of people to help her get her work done.

    I was just wondering if anyone has had the same problem. I am imaging that the medicine is wearing off and her dose or medicine needs to be changed. Also, I am not sure if the anxiety is caused from the adhd meds or if she really has anxitey.

    I just want to do the best for her so she can have a good childhood and enjoy herself. She cannot join group such as soccer or gymnastics because she wants to stand and pick her fingers the entire time. I want her to be able to enjoy these types of activities not stress her out.

    She is a lovable little girl who loves everyone but she just cannot get through school without hitting, kicking or picking.

    Any help would be appreciated. Thank you!

    Comment by Susan — Oct 26th 2011 @ 4:47 am
  5. Susan,

    My son Ryan was diagnosed ADD at the age of five and has had several similar characteristics. The major one ….. picking at his eye lids. Scary right ? he was always having dry lids and redness to the point of a detriment to his health. Neurologist suggested behavior modificationtherapy. He obcessed over many things, but the psychologist we went to said when you notice any especially obcessive behaviors they need to be nipped quickly. We have stopped obcessions over telebubbies, mickey mouse figurines, dressing, sidewalks, clucking like a chicken( tourettes side effect), etc. Rubbing his hands was a tourettes movement he developed. We put cream to heal his hands on at home with gloves on for a long time. The best I can say with these types of children is… be consistant. Mean what you say and they will believe you. At times I almost felt guilty because I gave a little tude back to my son, which he now thanks me for. Things can and will get better. I also applied gloves with large velcro straps over his hands once we got them to heal. might even try applying small bells on the gloves to remind her that when she hears the bells she needs to stop. Limit the use at first so she can get used to it. Teach her to clap instead of pick. Advise her to think about her favorite thing and resist the movement. Ask her everday how she did at resisting the behavior at school. Be creative, and expain it’s okay to have movements , just not ones that hurt yourself. She is old enough to understand this, kids are so smart ! No one has the exact answer for you , but i am certain you will find your way, like I did. Ryan is almost 15 now and only takes Intuniv 3 mg. He has become a staight a student and now has become self aware of how to change a behavior as soon as it starts. It has been a long road. He started out on adderall, and many other Add meds before we realized it was tourettes. These drugs often spur the tourettes on when taken. Special flesh colored gloves could be purchased and worn to gymnastics and would’nt be as noticable. Think outside the box , try new things till you get what you need darling. Best of luck in your quest!

    Comment by Heidi H — Oct 26th 2011 @ 7:35 am
  6. This could be PANDAS. All of this is very consistent with PANDAS which is treatable. It is hard to find a doctor who knows what it is and how to evaluate and treat it. It is an autoimmune problem that causes your immune system to attack the basal ganglia when exposed to strep. The antibodies think the basal ganglia is strep. You can carry strep in many places. My son really never gets it in his throat (once many years ago). His strep titers are always high. I have posted previously with website information and more resources. It may or may not be PANDAS, but it really should be ruled out first. There are some blood tests that may help to decide but a doctor really needs to evaluate the whole picture with the tests. Dr. Cunningham also conducts tests which help to indicate if it is PANDAS but it is a study and not covered by insurance. Sometimes, they have funding and can help cover costs. The book “Saving Sammy” covers one boys story if you are interested in learning more. If you suspect PANDAS, try finding a PANDAS knowledgeable doctor on the ACN Latitudes website. May God bless all of you and your families.

    Comment by Lori — Oct 26th 2011 @ 3:10 pm
  7. Susan,
    My son was recently put on Lexapro with Intuniv for Anxiety and ADHD. The Lexapro was great at first but after time i realized it made him more impulsive and hyperactive, very talkative, ect..Prior to Intuniv he was VERY moody in addition to his ADHD symptoms. I always suspected a mood disorder but Intuniv kept it at bay. We called the Psychiatrist right away and it appears that he had an adverse reaction to the Lexapro. Often antidepressants can cause a child who has a mood disorder to experience heightened behaviors such as impusivity, ect.. Be sure to discuss this with your Dr. if you think it is a concern. My son is almost 8 and is currently on Abilify and we are slowly getting him stable. The mood must be stable first before adding stimulants and.or antidepressants. By no means am I saying that your child has this. I’m just sharing my experience with the antidepressant association. Good luck and keep us “posted.”

    Comment by Melissa — Oct 27th 2011 @ 2:27 am
  8. just a quick update, it’s been a few weeks now on 2 mg of intuniv and my son is doing well on it ! there is so little info about adult usage but it seems that for now, at age 18, it is the right amt and the right rx for him. he might up it later if he needs to, but he is so relieved and happy that things are more under control. he told me that he feels like he lost the past year just from having to expend so much energy on controlling it all…. i’m so hoping it’s a permanent fix, although i realize that’s a bit idealistic. but his joy and relief is contagious so i’m riding the wave with him and just hope it lasts !

    Comment by miriam lerner — Oct 27th 2011 @ 2:59 pm
  9. Thank you for your input. We are seeing a Psychiatrist Friday thank goodness. She is now acting out in school in order to get a reaction. She is still picking but when they try to get her to stop, she lashes out at the teacher and her behavior elevates from there. She begins by hitting, then kicking and now she is throwing thing off of the teachers desk.

    I have got to get this under control or she is going to be kicked out of school.

    The only reason they have been so patient is because she has a IEP.

    Thanks again for sharing your stories with me.

    Comment by Susan — Nov 1st 2011 @ 2:18 am
  10. Make sure the IEP has a behavior plan with it. They can’t kick her out if her behavior is related to her diagnosis. Check out for information about her rights.

    Comment by Nancy — Nov 1st 2011 @ 4:08 am
  11. has anyone had any experience with changing Concerta with generic Concerta. The only thing I notice with my child is his stomache does not hurt as much ? However my co-worker thinks her son is not doing as well in school on the generic?
    we still have the tics, however, but we take the good with the bad?
    thanks for any info.

    Comment by Kathy — Nov 4th 2011 @ 7:57 pm
  12. My son is 6. He has shown tics, twitches, and clearing of the throat since school showed in august. Last year in school, I noticed it, but didn’t think much of it because it would come and go. Today was the first time he has taken Intuniv. His doctor said she would like to focus on ADHD (which he has not really had a problem with unless around other kids) before she goes further in testing. Today was his first day to take the meds. His teacher met me at the car after picking him up and said he was 5x worse today with the meds. Climbing up the walls. Running around the classroom. (He has had behavior issuses, but just blurting out and tapping pencils). I’m not sure if he is having a reverse affect or not? Has anyone else had this problem with this medicine?

    Comment by Ann — Nov 10th 2011 @ 10:21 pm
  13. Hi everyone, an update on my 9 year old. We met with a new psycharist and she put my daughter on respideral. It made my daughter very sleepy and very weepy but she did not pick at all. We cut the dosage back and it turned her very mean but still no picking. We took her off of the resperidal and put her on Adderall but the picking is back. I have a call in to see what we do now.


    Comment by Susan — Nov 16th 2011 @ 5:03 pm
  14. My son is 11 and has had many different tics over the years. He also has severe ADHD. We switched psychiatrists and she prescribed my son Intuniv. His tics have been just about non existant for months! *knock on wood* He still is VERY impulsive, so Im not sure that its helping his ADHD, but its been an awesome med for his tics!!!

    Comment by Amy — Aug 20th 2012 @ 2:58 am
  15. This is my first time on this site and I am so glad that I found it. My son was diagnosed with ADHD at the age of 6. He was placed on Adderal and developed Tics (mostly extreme eye blinking). Thankfully his doctor added Intuniv to his medications and the tics completely stopped. Shortly after that, we were able to discontinue the Adderal and just continue on the Intuniv (3 mg). It has been going great until very recently when the eye blinking started again.

    I have to say that the Intuniv has been a life saver for my son. I just wish I knew why the eye blinking was back. I guess we are ready for another (unplanned) visit to the pediatrician/neurologist.

    Oh, for all of the people out there that say medication is not the answer, my son has told me more times that I can count that his medication helps him be “normal” so kids don’t tease him at school. It is so nice to see him have friends at school and get report cards that have no negative behavioral remarks attached to them.

    Comment by Laurie — Sep 19th 2012 @ 9:28 pm
  16. All medicines are different for every child. @Laurie. Your son may be reacting greatly to this medicine and that is amazing. At the same time “all us people” who say it’s not the answer, it doesn’t make us wrong. Intuniv did not work for my son. It made it worse. He couldn’t control himself. It did not work for us. I’m so glad it has worked for you and others, but it doesn’t work for everyone. Also, after time, kids in this situation get immune to the medicine. That may be why the eye twithcing is back. My son has tourettes, so every year we have to experiment with medicines. Tourettes and ADHD have NO CURE so it’s everyday experimenting. Hopefully our children will grow out of it, but until then, fight thier battles with them, do not let them be alone and good luck to you all!!

    Comment by Ann — Sep 20th 2012 @ 11:20 am
  17. Just weighing in, here – my son is now 19, started on Intuniv last year and it was great for the first month or so, then had to be upped a couple of times, and finally stopped working, but left him groggy and “checked out.” He tried another medication during summer, I can’t remmeber what it was now, and he didn’t like the side effects of that one either. He switched to herbs in rotation – kratom ( extremely effective), blue lotus flower, valerian, st john’s wort. They all gave him great relief, but he had to time everything and make teas and it became it’s own kind of schedule and obsession. He took himself off of everything before returning for his sophomore year at college and is beginning to see a counselor for anxiety. Physical exercise is helpful, as is yoga and breathing ( I know with younger kids this isn’t necessarily be possible, but there might be yoga classes for children – incorporates breathing, intentional body work and stretching.)
    Good luck to everyone, it’s tough on the kids, they’re trying to fit in and feel good about themselves. Fortunately for my son, his school is full of super cool kids and he has an amazing cohort so he isn’t worried about their reactions to him, he just wants to feel comfortable in his own skin….

    Comment by miriam lerner — Sep 20th 2012 @ 11:43 am
  18. I would encourage anyone with kids who have tics (motor or vocal) to read up on PANDAS and see if that may be the underlying problem. There are not many doctors out there who know or understand how to treat it, but a lot of patients are misdiagnosed as tourettes and OCD, who have PANDAS. It is caused by an autoimmune response to strep and sometimes to other infections. It can cause anxiety, OCD (compulsions), tics, seperation anxiety, ADHD, and other problems. These kids can be helped. My son has this and has had eye twitching, having to touch walls as he walked, various tics (noises, funny arm or leg movements), pulling out hair and many others. They would come and go and change through the years. It took us a few years to figure out. He is doing much better now but still recovering. God bless you all and your kids.

    Comment by Lori — Sep 20th 2012 @ 1:09 pm
  19. It’s been many months since my last post, so thought I would share an update.

    My 10-year old son was diagnosed with Tourette’s and ADHD in 2010. His tics were more pronounced during stressful times (which for him are often in social situations) and his ADHD more obvious while in school. His first and only med was Intuniv, with gradual progression from 1mg to his current 3mg dosage. He had several side-effects initially (sleepiness and sleeplessness, mild stomach pain, diminished appetite), but we pushed through to see if they were temporary or long lasting. I’m so glad we continued; his body (and mind) acclimated to the meds and some successes followed.

    As with much in life, this experience has not been a straight trajectory. In Spring of this year, his teacher said he was losing focus, becoming a distraction, and the number and severity of tics had amplified. I felt that Intuniv was a good fit for him and thought an increase might be in order. He had not grown enough in height and weight for a higher dosage, so his med therapist suggested Vyvanse (as a secondary med to Intuniv). I opted to do nothing during the summer months (mostly because I was resistant to more meds), but when he returned to school, his impulsivity kicked in immediately.

    He started the Vyvanse in September, experienced some dizziness, felt marginally different, but after 2-3 days, said he felt so much better, was able to focus, and really enjoyed being at school. His tics come and go, but his overall self-confidence has improved in such a short, contributing to a noticeable decrease.

    After two years, plenty of frustration, and plenty of progress, I realize that he is going to change physically and emotionally and the effectiveness of his meds may not change with him. I live in the moment as much as possible, trying not to worry about who he may be in a year or two or 10, and do my best to work with what is.

    Kind regards.

    Comment by Natalie — Oct 26th 2012 @ 8:28 am
  20. Natalie, thanks for sharing your update! It’s so great to hear that you and yours are finding your way. And it’s a great reminder to all of us that this path is winding, and that success will mean different things at different times; the big picture is what matters most.

    Thanks again for the inspiration this morning!

    Comment by Heather — Oct 26th 2012 @ 8:42 am
  21. I am glad that you have found success. I have written a few times about my 19-year-old with a history of tics who tried Intuniv and another med over the summer (can’t remember the name of it now) and he was not happy with either. However, he has been using herbs with great success. It is an inexact science, to say the least, but there are no side effects and he has been systematic about figuring out his doses. The worst that happens is that they don’t help as much as he would like, but there is no such thing as overdosing or feeling so out of it from being drugged. Perhaps over summers or vacation times when there is more leisure time for experimentation you can try it out – and there are several that have been helpful to him. He either makes tinctures or teas, or puts the ground herbs into capsules. Here is a list of those he has tried, listed most effective first:
    St. Johns Wort
    Blue Lotus Flower
    There are several sites on the web you can order from. Some of the sites are kind of counter-culture and are advertising to those who wish to mix these herbs with alcohol for hallucinogenic effect, but rest assured that without combining with alcohol they are simply anti-spasmodic and calming herbs that produce no mind alteration whatsoever.
    I have seen my son visibly calmer and more relaxed after either drinking the tea or taking the herbs in capsule form ( that takes a bit longer.). He is in college and needs to concentrate to study and release anxiety, and this seems to be helping.
    Best of luck to all of us parents trying to help our darling and wonderful children navigate this challenge….

    Comment by Miriam — Oct 26th 2012 @ 2:28 pm
  22. I know I’m a little late in the game on this forum but i stumbled acrossed it and found it helpful. My son was diagnosed at 7 with tourettes (underlying OCD and ADHD) After many Dr. appt with many specialist i started a sugar free diet and my son went from being unable to write his name to his tics almost completely deminished. It was a miracle for us to not have to medicate and watch my son function without fail. But then came age 12 and the hormones that come along with it. I just got home from the Dr. and my son is starting Intuniv for his ADHD. His tics are still somewhat under control but he is suffocating in his studies. Praying and hoping we can find an answer. Not sure this is going to be it and I know this could be a very long and drawn out battle but it’s forums like this that give the lost some hope and light in the darkness. Thank you!

    Comment by Crystal — Jan 24th 2013 @ 4:46 pm
  23. My son is just 3 and a half years old and was recently diagnosed with severe ADHD & significant sensory disorders. He has also been diagnosed with PDD. They are wanting to put him on Intuniv or Tenex and I have been very hesitant. I can’t find much on these meds being used on children this young. Does anyone have a 3-4 year old that is currently being successfully treated with this med? He is very impulsive and aggressive towards himself and everyone else in the household, has constant “meltdowns” or tantrums everyday, and can not stay focused on ANYTHING….even things he seems to enjoy…he sees several specialists and therapists weekly …..Input please?!?

    Comment by Brittney — Jan 31st 2014 @ 1:45 pm
  24. This is for lovely Maria, who obviously doesn`t understand. I will pray for you Maria for you to someday come to understand that yes there are probably people out there that do medicate and they shouldn`t be BUT the Doctors are the ones that prescribe and we need to trust the Doctors. That being said I know from my experience my son suffered with mood swings, hyperactive so much that we couldn`t go places it sometimes became dangerous. Our son had anxiety attacts at age 7 that made him cry every night at 2am until 4am with sweats and frightening thoughts you think that is just being a normal kid you would probably just say go to bed well we as a family decided to not go on drugs when he was 7 we pushed it way for 2 years and our poor guy continued to suffer but like a diabetic they need their medication like these children they have a chemical disorder and it is out of their control who wouldn`t want to help their child get control of their life. Don`t be so judgemental Maria and when you experience this in your family maybe one day you will understand that it kills us Mothers that we have to see our child stuggle in this area and we have to give them a pill everyday just to get thru 8 hours and try to function as best as they can not so they can be perfect because NO one is perfect!

    Comment by heather — Feb 7th 2014 @ 12:12 pm

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