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Treating ADHD: Vyvanse vs Concerta

Vyvanse (lisdexamfetamine) and Concerta (an extended-release form of methylphenidate) 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 Vyvanse and Concerta come in.

Also read about Stimulants vs Non-Stimulants for treating ADHD


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 biggest difference between Vyvanse and Concerta, aside from their active ingredients, is that Vyvanse is a pro-drug. A pro-drug is inactive until your body converts it to its active form. This means that Vyvanse has a lower risk for misuse or abuse when compared to other stimulant medications.

They also differ slightly in how quickly they begin working in your body and how long their effects last. Vyvanse begins working within one hour and one dose lasts anywhere from 8-14 hours. Concerta can work much more quickly and effects can be seen anywhere from 20-60 minutes after administration. One dose lasts between 8-14 hours.

Concerta and its generic forms are only available as a tablet. Vyvanse, which does not currently have a generic form, can be found in both a capsule and chewable tablet; this may make it an easier option for children and those unable to swallow pills.

Concerta is approved by the FDA to treat ADHD in adults and children 3 years of age and older. Vyvanse has been approved to treat ADHD in adults and children 6 years of age and older.

What other conditions do they treat?
Concerta is also approved to treat narcolepsy, a condition that causes severe daytime sleepiness. Vyvanse is also approved to treat binge-eating disorder in adults.

Concerta has also been used to treat severe fatigue and major depressive disorder in medically ill patients with terminal illnesses, but it is not FDA approved for these indications.

Which is more effective?
Concerta and Vyvanse are both effective at treating ADHD. Each person is different, and one medicine may work better than another depending on your 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?
The generic formulation of Concerta is covered by most Medicare and commercial insurance plans; the brand name may not be covered or may come with a high copay. Because Vyvanse is only available under its brand name, most insurance companies will pay for it; however, they may require failed trials of other stimulant medications first. If you are having trouble paying for medications, Easy Drug Card may be able to provide medication discounts at one of the 65,000+ participating nationwide and local neighborhood pharmacies.

What are some common side effects?
Because Vyvanse and Concerta are so similar, they also have very similar side effect profiles. The most common side effects for both medications include:
• Trouble sleeping
• Feeling jittery or anxious
• Dry mouth
• Increased sweating
• Upset stomach or decreased appetite, which may lead to weight loss in some people

Another common side effect of Concerta is headache; this has not been reported as a common side effect for Vyvanse.

Rarely, Concerta has also been noted to cause priapism, which is a prolonged and painful erection. If you experience this side effect, you should seek medical attention right away.

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 Concerta and Vyvanse 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?
Vyvanse and Concerta 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.

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

Combining stimulant medications like Vyvanse and Concerta 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. Concerta. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021.
  3. Marion, DW. Vyvanse. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2021.
  4. Post, R. E., & Kurlansik, S. L. (2012). Diagnosis and management of attention-deficit/hyperactivity disorder in adults. American family physician, 85(9), 890-896.

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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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