Direct Dose Equivalence Between Concerta 72 mg and Vyvanse 60 mg
There is no established direct milligram-to-milligram equivalence between Concerta (methylphenidate) 72 mg and Vyvanse (lisdexamfetamine) 60 mg, as these are different stimulant classes with distinct pharmacokinetic profiles and mechanisms of action. However, based on available conversion guidance, Vyvanse 60 mg would generally require a higher dose of Concerta than 72 mg to achieve comparable clinical effect.
Practical Conversion Guidance
When switching from Vyvanse 70 mg (the closest studied dose to 60 mg) to OROS-methylphenidate (Concerta), the recommended equivalent is 54-72 mg once daily 1. This suggests that Vyvanse 60 mg would likely correspond to Concerta in the range of approximately 54-72 mg, making 72 mg Concerta potentially equivalent or slightly higher than Vyvanse 60 mg 1.
Key Pharmacological Differences
- Duration of action differs substantially: Concerta provides 12 hours of coverage, while Vyvanse (lisdexamfetamine) provides 13-14 hours of symptom control 2, 1
- Mechanism differences: Lisdexamfetamine is a prodrug requiring rate-limited hydrolysis by red blood cells to yield d-amphetamine, creating more sustained and larger effects on catecholaminergic neurotransmission than methylphenidate 3
- Neurochemical profiles diverge: Lisdexamfetamine increases dopamine, noradrenaline, and serotonin in both prefrontal cortex and striatum, while methylphenidate primarily affects dopamine and noradrenaline without significant serotonergic effects 3
Clinical Response Considerations
- Both medications have similar overall response rates of 70-80% in ADHD patients, but individual response varies significantly between stimulant classes 1, 4
- The 72 mg Concerta dose represents the maximum approved daily dose, while Vyvanse 60 mg is below the maximum of 70 mg, suggesting the Concerta patient may be at ceiling dose while the Vyvanse patient has room for titration 5, 1
- Regression analysis shows lisdexamfetamine produces greater increases in extracellular dopamine without locomotor activation compared to methylphenidate, indicating different therapeutic windows despite similar clinical efficacy 3
Practical Switching Algorithm
If switching between these medications:
- From Vyvanse 60 mg to Concerta: Start at 54 mg once daily in the morning, assess after 1 week, and increase to 72 mg if response is inadequate 1
- From Concerta 72 mg to Vyvanse: Start at 50-60 mg once daily in the morning, as the patient is already on maximum methylphenidate dose 1
- No cross-taper is necessary—the new medication can be started the next day after discontinuing the previous stimulant 2
- Monitor ADHD symptom control, blood pressure, heart rate, sleep quality, and appetite during the first week after any switch 1
Important Caveats
- Individual patient response trumps theoretical equivalence—some patients respond preferentially to amphetamine-based versus methylphenidate-based stimulants regardless of dose 4, 6
- Even with optimal dosing based on behavioral measures, subtle neurocognitive impairments may persist, so functional outcomes beyond symptom checklists should guide final dose selection 6
- The concept of "equivalence" assumes similar clinical endpoints, but duration of coverage needs may differ—a patient requiring 13-14 hours of coverage may not achieve equivalent functional outcomes with 12-hour Concerta even at higher doses 2, 1