Switching from Vyvanse 30mg to Concerta: Recommended Dose
Start with Concerta 36mg when switching from Vyvanse 30mg. 1
Dose Conversion Rationale
The conversion from Vyvanse 30mg to Concerta 36mg is based on established amphetamine-to-methylphenidate equivalency ratios:
- Vyvanse 30mg converts to approximately 8.9mg of active dextroamphetamine after metabolism, which is therapeutically equivalent to Concerta 36mg 1
- The amphetamine to methylphenidate conversion ratio is approximately 1:1.2 to 1:2 to achieve equivalent therapeutic effect 1
- Concerta 36mg provides methylphenidate coverage equivalent to approximately 12mg of immediate-release methylphenidate given three times daily 1
Transition Protocol
No washout period is required—you can switch directly from Vyvanse to Concerta the next day 1:
- Both medications have short half-lives, allowing immediate transition between stimulant classes 1
- Start Concerta 36mg on the first day after discontinuing Vyvanse 30mg 1
Monitoring and Dose Adjustment Strategy
Follow this algorithmic approach for dose optimization:
Week 1:
- Assess response after 1 week at the initial 36mg dose before making any adjustments 1
- Monitor for common side effects, particularly nausea, which occurs in up to 25% of patients starting methylphenidate-based medications 1
Week 2-4:
- If symptom control is inadequate after 1 week, increase to Concerta 54mg 1
- Allow at least 4 weeks at a therapeutic dose before determining treatment failure 1
Important Clinical Considerations
Duration of coverage:
- For patients requiring coverage beyond 12 hours, consider adding a small immediate-release methylphenidate dose in the late afternoon 1
- Concerta provides 12-hour coverage, which may differ from the patient's previous experience with Vyvanse 2
Cardiovascular monitoring:
- Continue cardiovascular monitoring as with any stimulant therapy 1
- Monitor blood pressure and heart rate at follow-up visits 3
Common Pitfalls to Avoid
- Do not start at Concerta 18mg—this is a lower equivalent dose than Vyvanse 30mg and will likely result in inadequate symptom control 1
- Do not wait longer than 1 week to assess initial response—this delays necessary dose adjustments 1
- Ensure patients receive OROS formulation (brand Concerta) rather than non-OROS generics, as non-OROS formulations have demonstrated inferior efficacy at equivalent doses 4