From the Guidelines
Methylphenidate (Ritalin) and lisdexamfetamine (Vyvanse) are both effective stimulant medications for treating ADHD, but Vyvanse is generally preferred due to its longer duration of action and smoother coverage throughout the day, as evidenced by the most recent study 1.
Comparison of Methylphenidate and Lisdexamfetamine
- Both medications are associated with similar side effects, including decreased appetite, sleep disturbances, and increased blood pressure and pulse 1.
- Methylphenidate is available in short-acting and extended-release formulations, while lisdexamfetamine is a long-acting medication that typically works for 10-14 hours after a single dose 1.
- Lisdexamfetamine has a more gradual onset and offset compared to methylphenidate, which may cause more noticeable "peaks and valleys" in symptom control 1.
- The prodrug nature of lisdexamfetamine reduces its abuse potential compared to methylphenidate 1.
Key Considerations
- When choosing between methylphenidate and lisdexamfetamine, factors such as symptom severity, presence of comorbidities, and patient preferences should be considered 1.
- Medication adherence is a common problem in ADHD treatment, and once-daily dosing (e.g., with lisdexamfetamine) may be preferred over twice-daily dosing to improve adherence 1.
- Regular assessment of medication adherence and open discussion of potential issues are crucial to ensure effective treatment 1.
Dosage and Administration
- Common doses for methylphenidate range from 5-20mg for immediate release (taken 2-3 times daily) or 18-72mg for extended release formulations 1.
- Lisdexamfetamine is typically prescribed at 30-70mg once daily 1.
- Healthcare providers should consider individual patient needs and adjust dosages accordingly, taking into account factors such as weight, age, and symptom response 1.
From the Research
Comparison of Methylphenidate and Lisdexamfetamine
- Methylphenidate and lisdexamfetamine are both used to treat attention deficit hyperactivity disorder (ADHD) 2, 3.
- Lisdexamfetamine is a prodrug of dextroamphetamine, which means it is converted into dextroamphetamine in the body, whereas methylphenidate works by inhibiting the reuptake of dopamine and norepinephrine 2, 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 in patients who had previously responded inadequately to methylphenidate 4.
- Another study found that lisdexamfetamine was generally well tolerated in clinical trials, with an adverse event profile typical of that reported for other long-acting stimulants 3.
- A meta-analysis comparing the efficacy and tolerability of medications for ADHD found that amphetamines (including lisdexamfetamine) were superior to methylphenidate in adults, while methylphenidate was preferred in children and adolescents 5.
- A direct comparison meta-analysis found that atomoxetine and methylphenidate had comparable efficacy in reducing core ADHD symptoms in children and adolescents, with atomoxetine demonstrating noninferiority to methylphenidate 6.
Efficacy and Safety
- Lisdexamfetamine has been shown to be effective in reducing ADHD symptoms in adults, with a significant improvement in symptoms compared to placebo 3.
- Methylphenidate has also been shown to be effective in reducing ADHD symptoms in children and adolescents, with a significant improvement in symptoms compared to placebo 5, 6.
- Both lisdexamfetamine and methylphenidate have been associated with adverse events, including headache, insomnia, anorexia, and weight loss 2, 3.
- Lisdexamfetamine has a lower potential for abuse compared to other stimulants, due to its prodrug mechanism of action 3.
Head-to-Head Comparisons
- A head-to-head comparison of lisdexamfetamine and atomoxetine found that lisdexamfetamine had a faster and more robust treatment response than atomoxetine in children and adolescents with ADHD who had previously responded inadequately to methylphenidate 4.
- A meta-analysis comparing the efficacy and tolerability of medications for ADHD found that amphetamines (including lisdexamfetamine) were superior to methylphenidate in adults, while methylphenidate was preferred in children and adolescents 5.
- A direct comparison meta-analysis found that atomoxetine and methylphenidate had comparable efficacy in reducing core ADHD symptoms in children and adolescents 6.