Guanfacine (Intuniv, Tenex) and Ketamine Therapy | Tovani Health
Intuniv (Guanfacine) (also: Tenex) — Alpha-2 adrenergic agonist (ADHD, anxiety)
Verdict at Tovani Health
Compatible; blood pressure and sedation are what we monitor.
Guanfacine and ketamine are compatible. Guanfacine lowers BP and adds sedation; ketamine transiently raises BP. The interaction works in opposite directions on BP but stacks on sedation. Orthostatic recovery after a session can be more pronounced.
If you take Intuniv regularly and are considering at-home ketamine therapy, the combination is safe with monitoring or dose adjustment. This page covers the brief pharmacologic context and what we do at intake.
How Intuniv interacts with ketamine
Guanfacine is a central alpha-2A agonist. It reduces sympathetic outflow, which can counteract ketamine's transient BP rise during the session but extend the orthostatic recovery period afterward.
What we do at intake
Tell us your dose and any history of orthostatic hypotension. We have you stand slowly and stay seated for several minutes after each session.
Bottom line
Guanfacine and ketamine are compatible. Guanfacine lowers BP and adds sedation; ketamine transiently raises BP. The interaction works in opposite directions on BP but stacks on sedation. Orthostatic recovery after a session can be more pronounced.
Frequently Asked Questions
Could guanfacine actually be useful during ketamine sessions?
Some clinicians use clonidine or guanfacine specifically to dampen the BP and HR rise. We have not adopted that as a routine, but it explains why the directional interaction is not necessarily a problem.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Intuniv (Guanfacine) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review. Veraart JKE, Smith-Apeldoorn SY, Bakker IM, et al.. International Journal of Neuropsychopharmacology. 2021. PMID: 34170315
Systematic review of pharmacodynamic interactions between ketamine and psychiatric medications used in depression treatment.
- Blood pressure safety of subanesthetic ketamine for depression: A report on 684 infusions. Riva-Posse P, Reiff CM, Edwards JA, et al.. Journal of Affective Disorders. 2018. PMID: 29525051
684-infusion case series documenting transient blood pressure elevation as the most common cardiovascular effect of subanesthetic ketamine; no serious adverse cardiovascular events.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 15, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.