What is the closest alternative to 10mg Vyvanse (lisdexamfetamine) and 5mg Adderall (amphetamine and dextroamphetamine) extended release?

Equivalent Alternative to 10mg Vyvanse and 5mg Adderall XR

The closest equivalent to 10mg Vyvanse and 5mg Adderall XR would be 10mg dexmethylphenidate extended-release (Focalin XR). 1, 2

Rationale for Recommendation

Understanding the Original Medications

1. Vyvanse (lisdexamfetamine)

   • Prodrug that converts to dextroamphetamine after ingestion 3, 4
   • 10mg is a low dose (below typical starting dose of 20-30mg)
   • Provides gradual release with effects lasting approximately 12-14 hours

2. Adderall XR (mixed amphetamine salts)

   • Contains 75% dextroamphetamine and 25% levoamphetamine 5
   • 5mg is at the lower end of the dosing range
   • Extended-release formulation provides approximately 12 hours of coverage
   • Uses immediate and delayed-release beads to create a biphasic release pattern 5

Why Dexmethylphenidate XR is the Best Alternative

• Pharmacological profile: Dexmethylphenidate extended-release provides a similar biphasic release pattern with immediate and delayed components, mimicking the combined effect of both medications 2
• Duration of action: Provides 12 hours of coverage, similar to the combined duration of Vyvanse and Adderall XR 2
• Dosing equivalence: 10mg dexmethylphenidate extended-release is approximately equivalent to the combined stimulant effect of 10mg Vyvanse and 5mg Adderall XR 1, 2
• Clinical guidelines: The American Academy of Child and Adolescent Psychiatry does not support combining different stimulant medications due to potential increased side effects and lack of evidence supporting improved outcomes 1

Important Clinical Considerations

Medication Conversion Cautions

• Monitoring needed: When switching between stimulant medications, careful monitoring for efficacy and side effects is essential
• Titration may be necessary: Start with 5mg dexmethylphenidate extended-release and titrate up to 10mg if needed 2
• Individual response varies: Some patients may respond differently to methylphenidate-based medications compared to amphetamine-based medications

Potential Pitfalls to Avoid

• Avoid combining stimulants: Guidelines specifically recommend against combining different stimulant medications 1
• Beware of timing: Dexmethylphenidate extended-release should be taken in the morning with or without food 2
• Monitor for side effects: Common side effects include decreased appetite, headache, anxiety, and dyspepsia 2
• Regular assessment: Monitor blood pressure, heart rate, growth (in pediatric patients), and psychiatric symptoms 1, 2

Alternative Options if Dexmethylphenidate XR is Not Suitable

1. Methylphenidate extended-release (Ritalin LA) - Similar biphasic release pattern 6
2. Single higher dose of Adderall XR - 15mg may provide similar coverage but with different pharmacokinetics
3. Single higher dose of Vyvanse - 30mg may provide similar coverage but with different pharmacokinetics

Remember that the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry recommend using a single stimulant medication rather than combinations for ADHD treatment 1.