What is the recommended starting dose of Concerta (methylphenidate) when switching from Vyvanse (lisdexamfetamine) 30mg?

Switching from Vyvanse 30mg to Concerta: Recommended Starting Dose

Start with Concerta 36mg once daily when switching from Vyvanse 30mg. This represents an appropriate conversion based on the relative potencies of amphetamine-based versus methylphenidate-based stimulants and provides comparable therapeutic coverage throughout the day.

Dose Conversion Rationale

• Amphetamine to methylphenidate conversion typically requires approximately 1:1.2 to 1:2 ratio to achieve equivalent therapeutic effect, though this varies by individual response 1
• Vyvanse 30mg (lisdexamfetamine) is converted to approximately 8.9mg of active dextroamphetamine after metabolism 1
• Concerta 36mg provides methylphenidate coverage equivalent to approximately 12mg of immediate-release methylphenidate given three times daily, making it a reasonable match for Vyvanse 30mg 1
• The 36mg dose of Concerta falls in the medium therapeutic range and allows room for both upward and downward titration based on response 2

Immediate Transition Protocol

• No washout period is required when switching between stimulant classes, as both medications have short half-lives and can be transitioned directly 3
• Administer Concerta in the morning (ideally with breakfast) on the day after the last Vyvanse dose 4
• Taking Concerta with food provides consistent drug exposure throughout the day, unlike amphetamine-based products where food significantly reduces early drug exposure 4

Monitoring and Titration Strategy

• Assess response after 1 week at the initial 36mg dose before making any adjustments 1
• If symptom control is inadequate after 1 week, increase to Concerta 54mg 1
• If side effects are problematic at 36mg, reduce to Concerta 18mg 1
• Allow at least 4 weeks at a therapeutic dose before determining treatment failure, as this represents an adequate trial period 1

Key Differences to Discuss With Patient

• Concerta provides 12-hour coverage with an ascending plasma profile, whereas Vyvanse provides relatively smooth coverage for 10-13 hours 5
• Concerta's osmotic delivery system (OROS) releases medication gradually throughout the day, with peak effects occurring 6-8 hours post-dose rather than the earlier peak seen with Vyvanse 1
• Patients may notice different timing of symptom control: Concerta may provide less robust early morning coverage but better afternoon/early evening control compared to Vyvanse 2

Common Pitfalls to Avoid

• Do not start with Concerta 18mg for a patient on Vyvanse 30mg, as this represents significant under-dosing and will likely result in inadequate symptom control 1
• Avoid switching to non-OROS generic methylphenidate ER products, as these have demonstrated inferior clinical outcomes compared to brand-name Concerta despite bioequivalence claims 6, 7
• Monitor for nausea during the first week, which occurs in up to 25% of patients starting methylphenidate-based medications; taking with food typically mitigates this 3
• Be aware that Concerta's effectiveness may vary more throughout the day compared to Vyvanse's smoother profile, requiring adjustment of expectations 5

Special Considerations

• For patients requiring coverage beyond 12 hours, consider adding a small immediate-release methylphenidate dose (5mg) in late afternoon rather than increasing Concerta dose 1
• If the patient was on Vyvanse specifically for its lower abuse potential, counsel that Concerta's OROS formulation also has reduced abuse potential compared to immediate-release formulations 3
• Cardiovascular monitoring (blood pressure and heart rate) should continue as with any stimulant therapy 1