What is the equivalent dose of Concerta (methylphenidate) for a patient currently taking Vyvanse (lisdexamfetamine) 40mg?

Converting Vyvanse 40mg to Concerta

Start Concerta at 36mg once daily in the morning, as there is no established direct dose equivalency between lisdexamfetamine (Vyvanse) and methylphenidate (Concerta), requiring empiric dosing with subsequent titration based on clinical response. 1

Rationale for Conversion Approach

Why Direct Conversion is Not Possible

• Lisdexamfetamine and methylphenidate are fundamentally different medication classes with distinct mechanisms of action and pharmacokinetics, making direct dose equivalency calculations impossible 1
• Lisdexamfetamine is a prodrug that converts to dextroamphetamine after ingestion, while methylphenidate is a direct-acting dopamine and norepinephrine reuptake inhibitor 2, 3
• The amphetamine class (Vyvanse) promotes neurotransmitter release in addition to blocking reuptake, whereas methylphenidate primarily inhibits reuptake 2

Recommended Starting Dose

• Begin Concerta at 36mg once daily in the morning when switching from Vyvanse 40mg, as this represents a standard mid-range starting dose for patients already on stimulant therapy 4, 5
• Discontinue Vyvanse abruptly without tapering when initiating Concerta, as no washout period is required between stimulant medications 1

Titration Strategy

Dose Adjustment Protocol

• If 36mg provides inadequate symptom control after 1 week, increase to 54mg once daily 4
• If 36mg produces excessive side effects, decrease to 18mg once daily 4, 5
• Maximum recommended dose is 72mg daily in adults 3
• Titrate in weekly increments based on clinical response and tolerability 4

Expected Timeline for Response

• Expect immediate therapeutic effects within hours of the first Concerta dose, similar to other stimulant medications 1
• Unlike non-stimulants, full clinical benefit does not require weeks of treatment 1
• Concerta provides 12-hour duration of action, covering the entire school or work day 4

Monitoring Parameters

Efficacy Assessment

• Monitor attention, focus, and task completion throughout the day, particularly noting coverage into evening hours 4
• Assess behavioral improvements in both structured (work/school) and unstructured (social) settings 4
• Use standardized rating scales or individualized daily target goals to objectively measure medication response 4

Safety Monitoring

• Monitor blood pressure and heart rate, as cardiac conduction effects can occur with methylphenidate 6
• Assess for dose-dependent side effects including decreased appetite, insomnia, irritability, and abdominal discomfort 4, 5
• Watch for behavioral deterioration across the day, which may indicate inadequate duration of coverage 4

Common Pitfalls to Avoid

• Do not assume equivalent efficacy at any particular dose ratio—individual response varies significantly between amphetamine and methylphenidate classes 1
• Do not attempt mathematical dose conversions based on stimulant equivalency tables, as these are unreliable for cross-class switches 1
• Avoid taking Concerta with high-fat meals if consistent timing relative to food intake cannot be maintained, as this can affect absorption 1
• Do not continue ineffective dosing for extended periods—if no response after 1 week at maximum tolerated dose, consider alternative medications 4