What is the equivalent dose of Vyvanse (lisdexamfetamine) when switching from Concerta (methylphenidate) 54mg?

Equivalent Vyvanse Dose for Concerta 54mg

When switching from Concerta 54mg to Vyvanse, start with Vyvanse 50mg based on the established amphetamine-to-methylphenidate conversion ratio of approximately 1:1.2 to 1:2. 1

Dose Conversion Calculation

The conversion is based on established stimulant equivalency ratios:

• Concerta 54mg delivers approximately 18mg of immediate-release methylphenidate equivalent given three times daily 2
• Using the 1:1.2 to 1:2 amphetamine-to-methylphenidate ratio, Concerta 54mg converts to approximately 40-50mg of Vyvanse 1
• The practical starting dose is Vyvanse 50mg, which can be titrated up to 70mg (the maximum approved dose) if needed 1, 3

Transition Protocol

Immediate Switch

• No washout period is required—you can switch directly between these medications on the same day 1
• Both stimulants have short half-lives that allow immediate transition without drug accumulation concerns 1

Initial Monitoring Period

• Assess symptom control after 1 week at Vyvanse 50mg before making adjustments 1
• If inadequate response after 1 week, increase to Vyvanse 60mg 1
• Allow at least 4 weeks at a therapeutic dose before determining treatment failure 1

Key Clinical Considerations

Pharmacologic Differences

• Vyvanse is a prodrug that requires hydrolysis in the blood to convert to active d-amphetamine, providing a smoother onset and potentially lower abuse liability compared to immediate-release amphetamines 4, 5
• Concerta uses an osmotic pump delivery system (OROS) designed for 12-hour coverage 6, 2
• Vyvanse typically provides 10-12 hours of symptom control 4

Common Pitfalls to Avoid

• Do not start at Vyvanse 70mg even though it's the maximum dose—this may cause excessive side effects when switching from methylphenidate to amphetamine 3
• Monitor for dry mouth, headache, and insomnia during the first week, as these are the most common side effects with Vyvanse 7
• Watch for appetite suppression and sleep disturbances, which should be similar between the two medications but may manifest differently 7, 2

Duration of Coverage

• If the patient requires coverage beyond 12 hours, consider adding a small immediate-release amphetamine dose in the late afternoon rather than increasing the Vyvanse dose 1
• This approach maintains symptom control without excessive total daily stimulant burden 1

Cardiovascular Monitoring

• Continue routine cardiovascular monitoring as with any stimulant therapy, including blood pressure and heart rate checks 1
• This is standard practice for all stimulant medications regardless of formulation 1