From the Guidelines
Alternatives to Concerta (methylphenidate) for treating ADHD include stimulant medications like Vyvanse (lisdexamfetamine, 30-70mg once daily) and non-stimulant medications like Strattera (atomoxetine, 40-100mg daily) or Intuniv (guanfacine, 1-4mg daily). When considering alternatives to Concerta, it's essential to evaluate the patient's symptom profile, side effect tolerance, medical history, and comorbid conditions.
- Stimulant options:
- Lisdexamfetamine (Vyvanse, 30-70mg once daily) 1
- Amphetamine-based medications like Adderall (mixed amphetamine salts, 5-30mg once or twice daily)
- Non-stimulant options:
- Atomoxetine (Strattera, 40-100mg daily), which works by inhibiting norepinephrine reuptake 1
- Guanfacine (Intuniv, 1-4mg daily), an alpha-2 adrenergic agonist 1
- Clonidine (Kapvay, 0.1-0.4mg daily), another alpha-2 agonist According to the most recent evidence, lisdexamfetamine should be preferred as the next option over non-stimulants if no desired benefit is observed after adequate treatment with methylphenidate 1. Medication adherence is a common problem in ADHD treatment, and factors like patient attitudes, physician-patient relationship, family support, and knowledge about the disorder and medication can influence adherence 1. The choice of medication and dosing regimen can also affect adherence, with once-daily dosing generally preferred over twice-daily dosing 1. Ultimately, the decision to initiate pharmacological treatment and the selection of a medication should be based on a thorough evaluation of the patient's individual needs and circumstances, considering factors like severity of symptoms, presence of comorbidities, and patient preferences 1.
From the Research
Alternatives to Concerta for Treating ADHD
Alternatives to Concerta (methylphenidate) for treating Attention Deficit Hyperactivity Disorder (ADHD) include:
- Other psychostimulants such as Adderall (a mixture of amphetamine salts) and Dexedrine (dexamphetamine) 2
- Non-stimulant medications like Strattera (atomoxetine), a selective noradrenaline reuptake inhibitor 2
- Other formulations of methylphenidate, such as Metadate CD, which utilizes a microbead technology to provide an 8-hour duration of action 3, 4
- Osmotic, controlled-release formulations of methylphenidate, such as Concerta, which provide a 12-hour duration of action 5
Comparison of Alternatives
Studies have compared the efficacy of different formulations of methylphenidate, including Concerta and Metadate CD:
- Metadate CD provides greater symptom control in the morning, while Concerta provides greater control in the early evening 4
- Lower doses of Metadate CD may be as effective as higher doses of Concerta in controlling symptoms 4
Pharmacogenetic Considerations
Pharmacogenetic factors can impact the pharmacokinetics of ADHD medications, including methylphenidate: