Converting from Concerta 36 mg to Adderall XR
Start Adderall XR at 10 mg once daily in the morning, then titrate by 5 mg weekly increments based on response, up to a maximum of 50 mg daily. 1, 2
Conversion Approach
There is no established direct dose equivalency between methylphenidate (Concerta) and amphetamine salts (Adderall XR) because these are different medication classes with distinct pharmacological profiles. 1 The standard approach is to:
Discontinue Concerta abruptly without tapering when switching to Adderall XR, as no washout period is required between stimulant medications 3
Begin Adderall XR at the standard starting dose of 10 mg once daily in the morning, regardless of the previous Concerta dose 1, 2
Titrate upward by 5 mg weekly increments until optimal symptom control is achieved, with a maximum dose of 50 mg daily 1, 2
Dosing Algorithm
- Week 1: Start 10 mg once daily in the morning 1, 2
- Week 2: Increase to 15 mg if needed 1, 2
- Week 3: Increase to 20 mg if needed 1, 2
- Continue weekly 5 mg increases until optimal response, not exceeding 50 mg daily 1, 2
Important Clinical Considerations
Adderall XR should be taken in the morning to minimize sleep disturbances, as late evening doses cause insomnia 2
Food effects differ significantly between these medications: Concerta provides consistent methylphenidate exposure regardless of food intake, while Adderall XR shows markedly lower amphetamine concentrations when taken with a high-fat breakfast, resulting in reduced early drug exposure 4
Monitor for common adverse effects including decreased appetite (35.6% in clinical trials), headache (16.3%), insomnia (12.0%), abdominal pain (10.7%), and weight loss (9.4%) 5
Assess cardiovascular parameters including blood pressure and heart rate at baseline and regularly during treatment, as amphetamines cause α-adrenergic vasoconstriction and β-adrenergic increases in heart rate and stroke volume 6
Efficacy Timeline
Expect immediate therapeutic effects within hours of the first dose, unlike non-stimulants such as atomoxetine which require 6-12 weeks for full benefit 3
Duration of action: Adderall XR provides symptom control for approximately 11-13 hours after morning dosing 7
Common Pitfall to Avoid
Do not attempt mathematical dose conversion between Concerta and Adderall XR based on milligram equivalents. The 36 mg Concerta dose does not translate to a specific Adderall XR dose—always start at 10 mg and titrate based on clinical response. 1, 2