Can I add Adderall (amphetamine and dextroamphetamine) 30mg Extended Release (XR) to Concerta (methylphenidate)?

Adderall XR and Concerta Should Not Be Combined

Combining Adderall XR 30mg with Concerta (methylphenidate) is not recommended due to potential increased side effects and lack of evidence supporting improved outcomes. 1

Rationale Against Combining Stimulants

Safety Concerns

• The American Academy of Child and Adolescent Psychiatry guidelines do not support combining different stimulant medications 1
• When stimulants are combined, side effects can be significantly increased:
  • Nausea, dry mouth, and tremor can be twice as common with combined stimulants compared to either drug alone 1
  • Increased risk of cardiovascular effects
  • Potential for heightened anxiety and insomnia

Pharmacological Considerations

• Both medications work through similar mechanisms:
  • Adderall XR (amphetamine/dextroamphetamine) increases dopamine and norepinephrine
  • Concerta (methylphenidate) blocks reuptake of these same neurotransmitters
• Combining these medications provides redundant mechanisms rather than complementary ones

Alternative Approaches

1. Optimize Current Medication First

   • If currently on Adderall XR 30mg:

     • Consider adjusting the dose (up to 50mg daily maximum) 2
     • Ensure proper timing of administration relative to meals for consistent absorption 3

   • If currently on Concerta:

     • Ensure using true OROS methylphenidate formulation (not generic non-OROS) 4
     • Titrate dose appropriately (up to approximately 1.0 mg/kg per day) 2

2. Switch Completely to One Medication

   • If switching from Adderall XR to Concerta:

     • Discontinue Adderall XR
     • Start Concerta at appropriate dose (typically 18-36mg)
     • Concerta has shown consistent drug delivery regardless of food intake 3
     • Some studies show Concerta may have advantages for neuropsychological functioning 5

   • If switching from Concerta to Adderall XR:

     • Discontinue Concerta
     • Start Adderall XR at appropriate dose (typically 10-20mg initially)
     • Be aware that food can affect early drug exposure with Adderall XR 3

Monitoring Recommendations

• Schedule follow-up 1-2 weeks after any medication change 2
• Monitor for common side effects:
  • Cardiovascular: blood pressure, heart rate
  • Appetite changes
  • Sleep disturbances
  • Mood changes or irritability

Special Considerations

• If ADHD symptoms are not adequately controlled with optimized stimulant monotherapy, consider:
  • Adding non-stimulant medications (e.g., alpha-2 agonists) under careful monitoring 1
  • Behavioral interventions to complement medication effects 2
  • Evaluating for comorbid conditions that may require separate treatment

Pitfalls to Avoid

• Avoid assuming that combining stimulants will provide additive benefits - evidence does not support this approach
• Do not overlook the importance of proper formulation - true OROS methylphenidate (Concerta) has different release properties than generic non-OROS versions 4
• Be cautious about patient reports of "wearing off" - this may indicate need for dose adjustment rather than adding another medication