What is the difference between Adderall (amphetamine and dextroamphetamine) and Vyvanse (lisdexamfetamine)?

From the Guidelines

Adderall and Vyvanse are two distinct medications for attention-deficit/hyperactivity disorder (ADHD) with different active ingredients, onset and duration of action, and potential for abuse. The primary difference between the two lies in their composition: Adderall is a combination of amphetamine salts, whereas Vyvanse contains lisdexamfetamine, which is metabolized into dextroamphetamine 1. This distinction results in Vyvanse having a slower onset of action, typically taking 1-2 hours to begin working, and a longer duration of 10-14 hours, compared to Adderall's quicker onset of 30 minutes and shorter duration of 4-6 hours for immediate-release and 8-12 hours for extended-release formulations. Some key points to consider when choosing between Adderall and Vyvanse include:

• Onset and duration of action: Vyvanse has a slower onset and longer duration compared to Adderall 1.
• Potential for abuse: Vyvanse is considered to have a lower potential for abuse due to its inactive form until metabolized by the body 1.
• Side effect profiles: Both medications have similar side effects, including decreased appetite, insomnia, increased heart rate, and anxiety, but some patients report fewer "ups and downs" with Vyvanse due to its smoother release mechanism 1.
• Dosing: Adderall dosing ranges from 5-40mg daily, while Vyvanse is typically prescribed as a once-daily dose ranging from 20-70mg 1. It is essential to consult a healthcare provider to determine the most suitable medication and dosage for individual patients, as both medications require regular monitoring and have potential side effects, such as increased blood pressure and heart rate, and reduced appetite, which can impact growth in children and adolescents 1.

From the FDA Drug Label

Lisdexamfetamine is a prodrug of dextroamphetamine. Amphetamines block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. The parent drug, lisdexamfetamine, does not bind to the sites responsible for the reuptake of norepinephrine and dopamine in vitro. Lisdexamfetamine is converted to dextroamphetamine and l-lysine primarily in blood due to the hydrolytic activity of red blood cells after oral administration of lisdexamfetamine dimesylate

The main difference between Adderall and Vyvanse is that:

• Adderall is a mixture of amphetamine salts, including dextroamphetamine and amphetamine.
• Vyvanse is a prodrug of dextroamphetamine, meaning it is converted into dextroamphetamine in the body.
• Vyvanse has a slower onset of action compared to Adderall due to its prodrug mechanism.
• The pharmacokinetics of Vyvanse are more predictable and have less variability compared to Adderall 2. The key differences are in their mechanism of action, pharmacokinetics, and formulation.

From the Research

Difference between Adderall and Vyvanse

• Adderall is a mixture of amphetamine salts, whereas Vyvanse is a prodrug of lisdexamfetamine, which is converted to dextroamphetamine in the body 3.
• Vyvanse has a slower release mechanism due to its prodrug design, which may lead to a lower potential for abuse compared to Adderall 3.
• Both medications are used to treat attention-deficit hyperactivity disorder (ADHD), but they have different pharmacokinetic profiles and may have different effects on patients 4.

Efficacy and Safety

• Studies have shown that Vyvanse has a high efficacy in reducing ADHD symptoms in adults, with a larger effect size compared to mixed amphetamine salts (Adderall) and methylphenidate 4.
• A head-to-head study comparing Vyvanse and atomoxetine found that Vyvanse had a faster and more robust treatment response in children and adolescents with ADHD 5.
• The safety profiles of both medications have been evaluated, with Vyvanse showing a reduced potential for abuse and Adderall being associated with a higher risk of adverse events such as psychosis and hostility/aggression 6, 7.

Adverse Events

• Adderall has been linked to adverse events such as coronary artery dissection, suicidal ideation, and completed suicide, particularly in males 6.
• Vyvanse has been associated with adverse events such as decreased appetite, insomnia, and anxiety, but its safety profile is generally considered to be consistent with that of other stimulant medications 5.
• A meta-analysis found that stimulant medications, including Adderall and Vyvanse, were associated with an increased risk of overall adverse events compared to placebo 7.