From the Guidelines
Vyvanse is generally preferred over Adderall due to its smoother onset of effects, longer duration of action, and lower abuse potential, as evidenced by its pharmacological profile as a prodrug that is metabolized to become active 1.
Key Differences Between Vyvanse and Adderall
- Onset and Duration of Action: Vyvanse has a gradual onset of effects over 1-2 hours and lasts 10-14 hours, whereas Adderall takes effect within 30 minutes and lasts 4-6 hours for immediate-release or 8-12 hours for extended-release formulations.
- Mechanism of Action: Both medications increase dopamine and norepinephrine levels in the brain, but Vyvanse's prodrug mechanism results in a more consistent and smoother experience.
- Side Effects and Abuse Potential: Vyvanse typically causes fewer side effects and has lower abuse potential than Adderall, making it a preferred choice for patients with concerns about misuse.
Considerations for Choosing Between Vyvanse and Adderall
- Individual Response: Patients may respond differently to each medication, and the choice between Vyvanse and Adderall should be based on individual response and side effect profile.
- Duration Needs: Vyvanse's longer duration of action may be beneficial for patients who require consistent symptom control throughout the day.
- Misuse Potential: Vyvanse's lower abuse potential makes it a preferred choice for patients with a history of substance abuse or concerns about misuse.
Clinical Implications
- Medication Adherence: The choice of medication should also consider factors that affect medication adherence, such as dosing regimen and patient preferences 1.
- Regular Assessment: Regular assessment of medication adherence and potential issues should be discussed openly with patients to improve treatment outcomes.
From the Research
Comparison of Vyvanse and Adderall in the Brain
- The effects of Vyvanse (lisdexamfetamine) and Adderall (mixed amphetamine salts) on the brain have been studied in various research papers 2, 3, 4, 5, 6.
- A study published in 2013 found that lisdexamfetamine did not serve as a positive reinforcer in cocaine-trained rats, and although it generalized fully to D-amfetamine, its discriminative effects were markedly influenced by its unusual pharmacokinetics 2.
- Another study published in 2017 compared the efficacy of lisdexamfetamine and extended-release methylphenidate in adolescents with attention-deficit/hyperactivity disorder (ADHD) and found that lisdexamfetamine was superior to methylphenidate in the forced-dose study but not the flexible-dose study 3.
- A meta-analysis published in 2019 evaluated the efficacy, acceptability, and tolerability of lisdexamfetamine, mixed amphetamine salts, modafinil, and methylphenidate in the treatment of ADHD in adults and found that lisdexamfetamine had the largest effect size and a promising potential for treating adults with ADHD 4.
- A study published in 2021 examined the distribution of methylphenidate, amphetamine, and lisdexamfetamine in the United States from 2010-2017 and found a rise in amphetamine and lisdexamfetamine distribution, which may correspond with a rise in adult ADHD diagnoses 5.
- A study published in 2014 compared the neurochemical and behavioral profiles of lisdexamfetamine, methylphenidate, and modafinil in freely-moving rats and found that lisdexamfetamine had larger and more sustained effects on catecholaminergic neurotransmission than methylphenidate or modafinil 6.
Key Findings
- Lisdexamfetamine and Adderall have different pharmacokinetic profiles, which may influence their effects on the brain 2, 6.
- Lisdexamfetamine may have a longer duration of action and better separation between its therapeutic actions and stimulant side-effects compared to methylphenidate 3, 6.
- The efficacy and tolerability of lisdexamfetamine and Adderall may vary depending on the population being studied, such as adolescents or adults with ADHD 3, 4.
- The distribution of lisdexamfetamine and Adderall may be influenced by regional and demographic factors, such as the percentage of Hispanic population per state 5.