Strattera (atomoxetine) vs Intuniv (guanfacine)
Strattera and Intuniv, compared on what the public record actually supports: side effects by rate from each FDA label, what the largest trial comparison found, who takes each one, who pays, what the labels warn, and what the litigation record holds. Sources on every number.
the short answer
- is Strattera or Intuniv more effective? there is no head-to-head trial record in our library that settles this pair, and we do not fill the gap with a guess. what can be compared is below: each label's own side-effect table, who takes each drug, who pays, and the legal record.
- which has fewer side effects? the labels say their trials “cannot be directly compared”, because each drug was tested in different people under different rules. what each label prints: Strattera (atomoxetine): 11.3% (61/541) stopped for an adverse reaction vs 3% (12/405) on placebo (Strattera label, SPL version 69, effective 2026-06-30). Intuniv (guanfacine): 54 (11%) — all doses of INTUNIV (N=513); by dose: 1 mg 2 (3%), 2 mg 10 (7%), 3 mg 15 (10%), 4 mg 27 (18%) stopped for an adverse reaction vs 4 (3%) (N=149) on placebo (Intuniv label, SPL version 44, effective 2025-06-23). the reactions both labels list, side by side, are in the table below.
- which should i take? not a question this page answers. the odds ratios are averages across thousands of strangers; your history, other medications and what you can live with are not in them. the questions for your prescriber below are built from what is on this page.
What this page will not do is rank them. These drugs are in different classes and were tested for partly different things, so a single-axis ranking would be a category error. Which one fits you turns on your history, your other medications, and side-effect trade-offs — a prescriber conversation. This page arms that conversation; here are the questions worth taking into it →
side effects by rate: what each label prints, not a head-to-head trial
the labels' own warning, first: “Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.” the two columns below come from different trials, in different people, under different inclusion rules. read each against its own placebo column, not against the other drug.
| reaction | STRATTERA (N=1,697) vs Placebo (N=1,560) | 1 mg (N=61) / 2 mg (N=150) / 3 mg (N=151) / 4 mg (N=151) / All Doses of INTUNIV (N=513) vs Placebo (N=149) |
|---|---|---|
| nausea | 26% vs 6% | 7% / 5% / 5% / 6% / 6% vs 2% |
| dry mouth | 20% vs 5% | 0% / 1% / 6% / 7% / 4% vs 1% |
| somnolence | 8% vs 5% | 28% / 30% / 38% / 51% / 38% vs 11% |
| dizziness | 8% vs 3% | 5% / 3% / 7% / 10% / 6% vs 4% |
| fatigue | 10% vs 6% | 10% / 13% / 17% / 15% / 14% vs 3% |
- Strattera (atomoxetine): 11.3% (61/541) stopped for an adverse reaction vs 3% (12/405) on placebo (Strattera label, SPL version 69, effective 2026-06-30).
- Intuniv (guanfacine): 54 (11%) — all doses of INTUNIV (N=513); by dose: 1 mg 2 (3%), 2 mg 10 (7%), 3 mg 15 (10%), 4 mg 27 (18%) stopped for an adverse reaction vs 4 (3%) (N=149) on placebo (Intuniv label, SPL version 44, effective 2025-06-23).
what makes each table, in the labels' words
- Strattera (atomoxetine), SPL version 69, effective 2026-06-30, 6 ADVERSE REACTIONS / 6.1 Clinical Trials Experience, capsules, for oral use. inclusion rule: “Commonly observed adverse reactions associated with the use of STRATTERA (incidence of 2% or greater) and not observed at an equivalent incidence among placebo-treated patients (STRATTERA incidence greater than placebo) are listed in Table 5.” trials: “STRATTERA was administered to 5,382 pediatric patients 6 years of age and older in clinical ADHD studies (Studies 1, 2, 3, 4, and 5) and 1,007 adults in clinical ADHD studies (Studies 6 and 7). In the ADHD clinical trials, 2,529 pediatric patients were treated for over 6 months which included 1,625 pediatric patients who were treated for longer than 1 year. The adult table covers "Acute Studies (up to 25 weeks)" per its caption — printed as "Table 5: Common Adverse Reactions Associated in Acute Studies (up to 25 weeks) of Adult Patients with ADHD" [sic — "Associated in" as printed].” DailyMed
- Intuniv (guanfacine (extended-release)), SPL version 44, effective 2025-06-23, 6 ADVERSE REACTIONS / 6.1 Clinical Trials Experience, INTUNIV extended-release tablets, for oral use. inclusion rule: “Most Common (≥5% and at least twice the rate for placebo) Adverse Reactions in Fixed Dose Studies 1 and 2 (label Table 3 caption).” trials: “The data described below reflect clinical trial exposure to INTUNIV in 2,825 patients. This includes 2,330 patients from completed studies in children and adolescents, ages 6 to 17 years and 495 patients in completed studies in adult healthy volunteers. From Section 14: Study 1 evaluated INTUNIV (2, 3, and 4 mg) for 5 weeks (n=345) and Study 2 evaluated INTUNIV (1, 2, 3, and 4 mg) for 6 weeks (n=324), both in children and adolescents aged 6 to 17 years; "Patients who weighed less than 25 kg were not included in either study."” DailyMed
every row above was transcribed from the current FDA label on 2026-09-08; the full tables, including the reactions only one label lists, are on side-effect rates, drug vs placebo. the sexual side-effect rows carry each label's own underreporting caveat on the SSRI sexual side effects page.
atomoxetine (Strattera)
non-stimulant (ADHD)
- FDA approval
- year not stated in our verified record · full approval journey →
- Who takes it (US, —)
- No year from 2014 to 2024 meets AHRQ’s reliability rule for this drug, so we print no count. Years not shown, under AHRQ’s reliability rule: 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024 (fewer than 60 survey respondents).Correction (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It showed 948,465 people and 4,208,253 prescriptions for 2024. No year meets AHRQ’s reliability rule for this drug, so that count is removed. It said prescriptions were up 64% since 2014; too few years meet the rule to show a trend, so that line is removed.
- Who pays (2024)
- Medicare: 327,343 claims · 66,109 beneficiariesMedicaid: ≥1,651,014 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
- Boxed warning
- Yes — on the current FDA label. read it in context →
- Adverse-event reports (FAERS)
- Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →26,970 all-time reports; most-reported terms: drug ineffective, nausea, fatigue
- Legal & safety record
- no dedicated record page yet; the journey page carries label history
guanfacine (Intuniv)
non-stimulant (ADHD, alpha-2 agonist)
- FDA approval
- year not stated in our verified record · full approval journey →
- Who takes it (US, 2019)
- 690,785 patients · 4,608,026 prescriptions (AHRQ MEPS)2014 → 2019: 2,630,263 → 4,608,026 prescriptions; later years fall under AHRQ’s reliability rule, so no direction is statedThe latest year shown is 2019: only 6 survey respondents reported it in 2024, under the 60 AHRQ requires.Correction (29 September 2026): An earlier version of this section took its numbers from ClinCalc DrugStats, a third-party site that republishes this survey; we now compute them from AHRQ’s public-use files ourselves. It showed 128,407 people and 826,201 prescriptions for 2024, a year that does not meet AHRQ’s reliability rule; the latest year that does is 2019. It said prescriptions were down 69% since 2014; the series stops in 2019 because later years fail the rule, so we state no direction.
- Who pays (2024)
- Medicare: 252,004 claims · 46,955 beneficiariesMedicaid: ≥3,999,736 prescriptionsCommercial claims: not published in any public dataset — a real absence, not a zero.
- Boxed warning
- None on the current FDA label in our record.
- Adverse-event reports (FAERS)
- Caveat first: FAERS counts unverified REPORTS, not patients or rates — no denominator, and attention inflates reporting. Never compare these counts head-to-head; a longer-marketed, more-prescribed drug accumulates more reports by exposure alone. how to read FAERS →7,823 all-time reports; most-reported terms: drug ineffective, off label use, somnolence
- Legal & safety record
- no dedicated record page yet; the journey page carries label history
questions for your prescriber, built from this page
this page does not tell you to start, stop or switch anything. it arms the conversation where that decision belongs. take these in:
- which of Strattera and Intuniv did you have in mind first, and what in my history points that way?
- these two are different classes (non-stimulant (ADHD); non-stimulant (ADHD, alpha-2 agonist)). what are they each being asked to do for me, and is that use on the label or off it?
- the label lists these reactions above placebo for the one you're suggesting. which of them should i expect in the first weeks, and which would make you want to hear from me the same day?
- how long were the approval trials, and what do we know past that point?
- how will we judge whether it is working, by when, and what is the plan if it isn't?
- if i ever want to come off it, how is that done, and over how long?
- is there a cheaper generic or a formulation that changes the dosing, and does my insurance prefer one of these two?
the longer checklist, for any antidepressant, is questions to ask before starting antidepressants. if you are already on one and it feels like it stopped working, that has its own page.
What the warnings mean, drug by drug
Each explainer reads one drug's current FDA label and the studies in our library, in both directions: the boxed warnings with the label's own numbers, the trials behind the approval and how long they ran, side effects by rate, and the research since.
Questions people search
Is Strattera or Intuniv better?
No honest page can answer that in one line. Head-to-head differences between comparable psychiatric medications are usually smaller than rankings suggest, and which fits you depends on your history, other medications, and side-effect trade-offs, a prescriber conversation. What can be compared is the public record (usage, payers, label warnings, approval history, litigation), which is what this page does, with sources.
Is Strattera the same as atomoxetine, and Intuniv the same as guanfacine?
Strattera is a brand name for atomoxetine. Intuniv is a brand name for guanfacine. atomoxetine is a non-stimulant (ADHD); guanfacine is a non-stimulant (ADHD, alpha-2 agonist). This page uses the generic names because the federal datasets do.
Which has fewer side effects, Strattera or Intuniv?
The two FDA labels cannot be compared head to head, in their own words, because each drug's trials ran in different people under different rules. What each label prints: Strattera (atomoxetine): 11.3% (61/541) stopped for an adverse reaction vs 3% (12/405) on placebo (Strattera label, SPL version 69, effective 2026-06-30). Intuniv (guanfacine): 54 (11%) — all doses of INTUNIV (N=513); by dose: 1 mg 2 (3%), 2 mg 10 (7%), 3 mg 15 (10%), 4 mg 27 (18%) stopped for an adverse reaction vs 4 (3%) (N=149) on placebo (Intuniv label, SPL version 44, effective 2025-06-23). The page shows the reactions both labels list, each against its own placebo column.
Which is prescribed more, Strattera or Intuniv?
The page shows federal survey estimates we compute from AHRQ’s Medical Expenditure Panel Survey public-use files for both atomoxetine and guanfacine: patients and prescriptions in the latest reliable year, and the yearly series from 2014 where AHRQ’s reliability rule allows it, with a direction stated only when the change is larger than the survey’s margin of error. Prescription volume reflects habits, prices, and marketing as much as evidence, so it is context, not a verdict.
Where these numbers come from
- Patients and prescriptions: computed by us from AHRQ's public-use Medical Expenditure Panel Survey Prescribed Medicines files, 2014 (HC-168A) to 2024 (HC-254A), with AHRQ's reliability rule (a year with fewer than 60 respondents or a relative standard error over 50% is not shown) — counts of people filling prescriptions, not outcomes. A direction is stated only when the change is larger than the survey's margin of error. Until 29 September 2026 these came from ClinCalc DrugStats, a third-party site; see the correction under each drug where a figure changed.
- Medicare/Medicaid: CMS public datasets; commercial insurance publishes no per-drug series, so it renders as an absence, never a synthesized number.
- Label facts: the drugs' current FDA labels via DailyMed — quoted in context on each drug's approval-journey page.
- FAERS: openFDA — reports, never rates; the caveat travels above every count.
- Litigation: court records and regulator documents only, on the linked record pages; settled is never adjudicated.
Explore both drugs in depth: /m/atomoxetine · /m/guanfacine · or the whole library →