Switching from Concerta 36 mg to Vyvanse
When switching from Concerta 36 mg to Vyvanse (lisdexamfetamine), start with Vyvanse 30 mg once daily in the morning and titrate upward in weekly intervals based on response, as there is no established direct dose conversion between methylphenidate and amphetamine products.
Rationale for the Switch
The decision to switch from methylphenidate (Concerta) to lisdexamfetamine should be based on inadequate response or intolerable adverse effects with methylphenidate. If no desired benefit is observed after adequate treatment with methylphenidate, lisdexamfetamine should be the preferred next option over non-stimulants 1. Research demonstrates that more than 90% of patients will respond to one psychostimulant if medications from both methylphenidate and amphetamine classes are tried 2.
Switching Protocol
Step 1: Discontinue Concerta
- Stop Concerta 36 mg without tapering (stimulants can be discontinued abruptly without withdrawal concerns in most cases)
- No washout period is required between methylphenidate and lisdexamfetamine
Step 2: Initial Vyvanse Dosing
Start with Vyvanse 30 mg once daily in the morning 3. This conservative starting dose is appropriate regardless of the previous Concerta dose because:
- There is no validated conversion ratio between methylphenidate and amphetamine products
- Individual response to different stimulant classes is unpredictable 2
- Lisdexamfetamine has a 12-hour duration of action with slow onset due to its prodrug formulation 3, 4
Step 3: Titration Schedule
- Increase dose weekly if needed: 30 mg → 50 mg → 70 mg
- Maximum dose is 70 mg daily
- Assess response at each dose level for at least 7 days before increasing 2
- Titration can be accomplished in as few as 3 days in urgent situations 2
Monitoring During the Switch
Efficacy Assessment
Monitor for improvement in:
- ADHD core symptoms (inattention, hyperactivity, impulsivity)
- Functional impairment at school/work
- Duration of symptom control throughout the day
Safety Monitoring
Common adverse effects to monitor (more frequent with lisdexamfetamine than methylphenidate) 5, 6:
- Decreased appetite (62.4%)
- Insomnia (28.7%)
- Irritability/aggression (26.1%)
- Weight loss (21.1%)
- Mood swings (13.9%)
Check vital signs at each visit, particularly blood pressure and heart rate.
Important Clinical Considerations
Why This Approach Works
Research shows that 41% of patients require switching from their initial stimulant family due to poor tolerability or lack of efficacy 7. Lisdexamfetamine demonstrates statistically significantly greater improvement in ADHD symptoms compared to OROS methylphenidate (Concerta) in head-to-head comparisons 6, with a number needed to treat of 6 for achieving clinical response.
Common Pitfalls to Avoid
- Do not attempt direct dose conversion - Response to different stimulant classes is variable and unpredictable 2
- Do not start at maximum dose - Begin conservatively at 30 mg despite previous Concerta dose
- Do not rush titration - Allow adequate time (at least 7 days) to assess response at each dose level
- Do not overlook cardiovascular screening - Assess cardiac history and perform physical exam before initiating 8
Expected Timeline
- Initial response may be seen within days of starting lisdexamfetamine
- Optimal dose typically achieved within 3-4 weeks
- Among children switching to lisdexamfetamine, 41.3% continue treatment for a year or longer 5
When to Consider Alternative Options
If lisdexamfetamine fails due to adverse effects or lack of efficacy after adequate trial at optimal doses, consider atomoxetine or other non-stimulant options as third-line therapy 1.