Question: I am a 44 year old male with ADD and take adderall (5mg 2x daily) and Guanfacine (generic brand for Intuniv) 2-3 mg daily. I weigh ~ 160 lbs. I initially tried Strattera from my ADD and had significant side effects; urinary incontinence along with painful sexually ejaculations ... including, ejaculations that occurred very quickly with little to no psychical contact - this was never something I had never experienced prior to the Strattera. These urinary and sexual discomfort were very pronounced. My doctor switched me to guanfacine, and those issues initially improved. But after a few months on Guanfacine, I am have urinary incontinence, feeling like my bladder is never fully voided, and have to get up two to three times a night to go to the bathroom. I had fully bloodwork and my kidneys and liver functions are normal. My prostate was checked by a urologist about a year and half ago and he found it to be normal. I had a CAT scan done on my abdomen & pelvis about the about time and it was clear, outside of some diverticulosis. Could my issues be related to my any of medications?

Dr. Bansai,

I appreciate your detailed explanation. I have responded in CAPS below to your questions, and have 3 followup questions:

Do you get bladder sensation of fullness once urine collects? YES
Can you hold urine till you reach bathroom? YES
Can you start the process of urination? YES
Can you yourself stop the process of urination? YES
Once passed the urine- none remains in the bladder? - This needs to be confirmed by ultrasound. THIS HAS NOT BEEN DONE

Follow up questions:
1) Outside of impotence, is there a notable risk of long term complications resulting from these type of continued side effects i.e., increased urgency to urinate, what seem to be decreased volume capacity of my bladder, and some broken stream urination (start and stop), and slightly painful ejaculations. It seems to me that it would be hard on my body and overtime complication may arise.

2) From the XXXXXXX of the urinary issues only - if you had to select an Rx to first eliminate or decrease dosage which would it be? From my ADD treatment perspective, I would say that my adderall dosage is very low at 5mg twice daily, however it provides a notable positive impact on my ADD. The Guanfacine causes my blood pressure to decrease occasionally too significantly low levels at time. My thought is too speak to my physician about eliminating the Guanfacine first. My doctor didn't seem overly concerned over the urinary side effects of Strattera (but, it should be noted he was a research doctor for Strattera), but it was so troublesome to me that he agreed to switch to the guanfacine.

3) Lastly this might be outside your expertise, but since taking these medications my irritability has notably increased - any thoughts on whether one of the Rx would be a likely suspect. Thanks again, two