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Medication showdown: Ritalin vs. Adderall

ADHD medication showdown: Ritalin vs. Adderall

Ritalin (methylphenidate) and Adderall (amphetamine/dextroamphetamine) are first-line stimulant medications that are used to treat attention deficit hyperactivity disorder, or ADHD. ADHD includes symptoms of hyperactivity, impulsivity, and inattention that begins in childhood and causes difficulty across many different settings (including at school, at home, and with friends). ADHD can also last into adulthood, affecting work, home life, and relationships. Sometimes behavioral therapy alone is enough to treat ADHD, but combination treatment with medication is often needed. That’s where stimulants like Ritalin and Adderall come in.

But how do they work?

Stimulant medications help improve focus and alertness by blocking the reuptake of certain “messengers,” or neurotransmitters called norepinephrine and dopamine in the brain. Norepinephrine affects the sleep-wake cycle in your brain and can also impact attention, focus, and memory storage; dopamine affects pleasure and attention span. People with ADHD have an imbalance of dopamine and norepinephrine in their brains, so blocking reabsorption allows these messenger chemical levels to increase and improve symptoms of ADHD.

What are the main differences?

The main differences between Ritalin and Adderall are their active ingredients and how quickly they work and stay in your body. Ritalin contains methylphenidate hydrochloride and Adderall contains both amphetamine and dextroamphetamine. Ritalin is shorter-acting, which means it reaches peak levels in your body much more quickly than Adderall. Ritalin usually starts working within 20-60 minutes while Adderall may take up to 3 hours for effects to be seen. One dose of Ritalin will usually last for 3-6 hours, while Adderall® usually lasts 5-7 hours. There are also extended release formulations of both medications that last as long as 12 hours. Both Ritalin and Adderall are approved for use in adults and children 3 years of age and older for the treatment of ADHD.

What other conditions do they treat?

Both Ritalin and Adderall are also approved to treat narcolepsy, a condition that causes severe daytime sleepiness. These medications have also been used to treat severe fatigue and major depressive disorder in medically ill patients with terminal illnesses, but they are not FDA approved for these indications.

Which is more effective?

Ritalin and Adderall are both effective in treating ADHD and narcolepsy. Each person is different, and one medicine may work better than another depending on the body’s unique response. Only your doctor can help you decide which medication is best for you, and it may require some trial and error before the correct medicine and dosing is found.

How much do they cost?

Most Medicare and insurance plans will pay for the generic forms of immediate release Ritalin and Adderall, but the cash price of these medications can get expensive. A 30 day supply of Ritalin or Adderall can average almost $100 in the Denver metro area. Depending on which pharmacy you use, Easy Drug Card discounts can lower those prices to less than $40.

What are some common side effects?

Because Ritalin and Adderall are so similar, their side effect profiles are almost identical. The most common side effects for both medications include headache, insomnia or trouble sleeping, dry mouth, increased heart rate, and nausea. These medicines can also cause stomach pain and decreased appetite, which may lead to weight loss in some people.

Mood changes such as depression and suicidal ideation are rare but important side effects to be aware of.

Long term use of stimulants in children can slow their growth. It is very important that height, weight, and other vital signs are monitored regularly by a medical professional.

Rarely, stimulant medications like Ritalin and Adderall can cause an increased risk of cardiovascular events, like a heart attack or stroke. People with a history of heart problems should use caution when taking these medications.

What other important info should I know?

Ritalin and Adderall are both categorized as Schedule II controlled substances by the DEA. This means they have a high potential for abuse and use may lead to severe psychological or physical dependence. These medications should never be taken without careful medical evaluation and a prescription from your doctor.

Ritalin and Adderall, as well as other stimulant medications, are not safe to use during pregnancy or breastfeeding.

Combining stimulant medications like Ritalin and Adderall with alcohol is unsafe and can lead to enhanced and unpredictable medication effects.

References:

1. Croke, L. M. (2013). AAP releases guideline on diagnosis, evaluation, and treatment of ADHD. American family physician, 87(1), 61.

2. Marion, DW. Adderall. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021.

3. Marion, DW. Ritalin. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021.

4. Sherzada, Awista (2012) “An Analysis of ADHD Drugs: Ritalin and Adderall,” JCCC Honors Journal: Vol. 3 : Iss. 1 , Article 2.

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ABOUT THE AUTHOR

Dr. Joanna L. Hodder

Dr. Joanna L. Hodder is a transitions of care pharmacist for a large hospital system in Denver, Colorado. She received her BA in English Literature from Iowa State University and PharmD from University of Minnesota College of Pharmacy. Dr. Hodder completed a post-graduate year 1 (PGY-1) residency at Northeast Iowa Family Practice Center, where she delivered quality patient care in both hospital and primary care settings. She is passionate about empowering patients to take charge of their health through evidence-based education and improving access to medications. When she isn’t working closely with patients, Dr. Hodder enjoys gardening, hiking with her dog, and yoga.

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