What is the comparison between Concerta (Methylphenidate) and Vyvanse (Lisdexamfetamine)?

From the Guidelines

Concerta and Vyvanse are both effective stimulant medications for treating ADHD, but the choice between them should be based on individual patient response and side effect profiles, with consideration of their distinct mechanisms of action and pharmacokinetic profiles, as noted in the most recent study 1.

Key Differences

• Concerta contains methylphenidate, which works for about 10-12 hours, releasing medication gradually through an osmotic system, and is available in 18mg, 27mg, 36mg, and 54mg doses.
• Vyvanse contains lisdexamfetamine, a prodrug that converts to dextroamphetamine in the body, lasting about 10-14 hours, and comes in doses ranging from 10mg to 70mg.

Side Effects and Considerations

• Both medications can cause decreased appetite, insomnia, and increased heart rate, but the specific side effect profile may differ slightly.
• Neither medication should be taken with monoamine oxidase inhibitors, and both are controlled substances due to potential for abuse.
• The most recent study 1 notes that psychostimulants, including methylphenidate and amphetamine, are associated with a range of adverse effects, which are generally acceptable as they are predominantly mild and/or temporary.

Clinical Guidelines and Recommendations

• Clinical guidelines generally recommend monitoring of pulse and blood pressure when prescribing psychostimulant medication, as noted in 1.
• The choice between Concerta and Vyvanse depends on individual response, as some patients respond better to methylphenidate-based medications while others do better with amphetamine-based ones, as suggested in 1 and 1.
• If one medication doesn't work well or causes problematic side effects, trying the other may be beneficial under medical supervision, as noted in the example answer.

Important Considerations for Special Populations

• For adolescents, special concern should be taken to provide medication coverage for symptom control while driving, and longer-acting or late-afternoon, short-acting medications might be helpful, as noted in 1.
• Clinicians should monitor symptoms and prescription-refill requests for signs of misuse or diversion of ADHD medication, and consider prescribing medications with no abuse potential or stimulant medications with less abuse potential, such as lisdexamfetamine (Vyvanse), as suggested in 1.

From the Research

Comparison of Concerta (Methylphenidate) and Vyvanse (Lisdexamfetamine)

• Both Concerta (Methylphenidate) and Vyvanse (Lisdexamfetamine) are used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) 2, 3.
• Methylphenidate, the active ingredient in Concerta, works by inhibiting the reuptake of dopamine and norepinephrine, while Lisdexamfetamine, the active ingredient in Vyvanse, is a prodrug of dextroamphetamine that increases presynaptic release of dopamine and other biogenic amines in the brain 3.
• A study comparing the efficacy and safety of Lisdexamfetamine and Atomoxetine in children and adolescents with ADHD found that Lisdexamfetamine had a faster and more robust treatment response than Atomoxetine, with a median time to first clinical response of 12 days compared to 21 days for Atomoxetine 4.
• Another study found that Lisdexamfetamine was effective in reducing ADHD symptoms in adults, with a post hoc analysis suggesting that the response to Lisdexamfetamine was generally similar in treatment-naïve patients and those who had already received and not responded satisfactorily to previous ADHD therapies, including Methylphenidate 5.
• In terms of safety, both Concerta and Vyvanse have been associated with adverse effects such as headache, insomnia, anorexia, and weight loss, and have a high potential for abuse and dependence 3, 4, 5.
• A study comparing the treatment effectiveness of OROS (osmotic-release oral system) Methylphenidate ER (Concerta) and non-OROS Methylphenidate ER found that OROS Methylphenidate ER was more effective in reducing ADHD symptoms, with a significant reduction in mean T-score on the Inattention Scale 6.

Key Differences

• Concerta (Methylphenidate) is available in a 12-hour preparation, while Vyvanse (Lisdexamfetamine) is available in a once-daily oral regimen 2, 5.
• Lisdexamfetamine has a lower feasibility for abuse compared to other stimulants, including Methylphenidate 3.
• The response to Lisdexamfetamine was generally similar in treatment-naïve patients and those who had already received and not responded satisfactorily to previous ADHD therapies, including Methylphenidate 5.