Concerta vs Vyvanse: ADHD Medications Comparison

Overview

• Purpose: Compare Concerta and Vyvanse to determine the best ADHD medication.
• Medications:
  • Concerta: Brand name for methylphenidate extended release
  • Vyvanse: Brand name for Lisdexamphetamine

Medication Categories and Mechanism

• **Categories: **
  • Concerta: Methylphenidate-based
  • Vyvanse: Amphetamine-based
• **Mechanism: ** Increase dopamine and norepinephrine activity in the brain.

Approved Uses

• Concerta:
  • ADHD (adults and children 6+)
  • Narcolepsy
• **Vyvanse: **
  • ADHD (adults and children 6+)
  • Binge eating disorder
• **Off-label uses: ** Treat obesity and treatment-resistant depression.

Dosage Forms and Administration

• Concerta: Tablets (18-72 mg daily)
  • Don't crush or chew.
• Vyvanse: Capsules/Chewable form (10-70 mg daily)
  • Capsules can be mixed with liquids or food.

Release Mechanism

• **Concerta: **
  • Osmotic Release Oral System (Oros)
  • 22% dose released in the first hour
  • Rate-controlled remainder through laser-drilled holes
  • Drug compartments release medication over 10-12 hours
• **Vyvanse: **
  • Lysine-bound to dextroamphetamine, makes it inactive until enzymatic conversion in the body
  • Lasts around 12-14 hours
  • Less potent than straight dextroamphetamine

Side Effects

• **Concerta: **
  • Decreased appetite
  • Headaches
  • Dry mouth
  • Nausea
  • Insomnia
• Vyvanse:
  • Decreased appetite
  • Insomnia
  • Upper abdominal pain
  • Irritability
  • Vomiting

Growth Effects in Children

• Concerta:
  • Slower growth rate;
  • Decrease in height over 3 years: ~2 cm
  • Weight loss: ~2.7 kg (6 lbs)
• Vyvanse:
  • Controlled trial showed weight loss: 0.9-2.5 lbs (higher dose, more weight loss)
  • Higher weight loss in teens vs. children

Costs

• Concerta: Brand and generic available; ~$44 for 30 days
• Vyvanse: Only brand available; ~$353 for 30 days; Generic version expected in 2023

Research Studies

• 2013 CNS Drugs Study: Vyvanse > Concerta in ADHD symptom improvement
• 2014 Meta-analysis: Vyvanse > methylphenidate (Concerta) and Stratera for ADHD in children and teens
• 2017 CNS Drugs Study: Vyvanse > Concerta in ADHD treatment for teens
• 2013 Journal of Medical Economics Study: Concerta better tolerated than Vyvanse
• 2018 Lancet Study:
  • Methylphenidate products (Concerta) recommended first line in kids and teens
  • Amphetamine-based products (Vyvanse) preferred for adults

Conclusion

• Both medications are effective and more potent than placebo.
• Vyvanse may be more effective, while Concerta has better adherence.
• Consider side effects, costs, and individual tolerance when choosing a treatment.