Concerta and Vyvanse are two of the most commonly prescribed ADHD medications on the market. But how do they stack up against each other and which medication is best? Today, we're going to compare them head-to-head and by the end of this video, you're going to have a better idea of which medication would be right for you. All right, let's first start off by making sure we're all talking about the same medications here. Okay, remember each medication usually has a generic and a brand name and physicians will use these names interchangeably. So Concerta is the brand name and methylphenidate extended release is the generic name. With Vyvanse, that's the brand name and Lisdexamphetamine is the generic name. Make sense? Now, how do these medications work? Both are considered to be stimulant medications. And when we're talking about stimulants, there are two different categories to consider. Here. There's the amphetamine-based product and the methylphenidate-based products. Concerta is in the methylphenidate group and Vyvanse is in the amphetamine group. And at a basic level, both of these medications work by increasing the activity of dopamine and norepinephrine in certain parts of the brain. And so what conditions do these medications treat? In adults, Concerta is FDA approved for the treatment of ADHD and narcolepsy, while Vyvanse is approved for ADHD and binge eating disorder. Both are also approved for the treatment of ADHD in children 6 and older, and both are used off-label to treat obesity and treatment-resistant depression. Concerta comes in tablets, and the dose range is generally between 18 to 72 mg daily, whereas Vyvanse comes in a capsule, and dosing is between 10 to 70 mg daily. With Concerta, it's important that you don't crush or chew the tablets, because doing so will mess up how the medication is released, whereas with Vyvanse, the capsule can be opened and mixed with orange juice, yogurt, or water. It also comes in a chewable form that is strawberry flavored, so it's definitely the better option if you're unable to swallow pills. So both of these medications are considered to be long-acting stimulants, and I want to talk real quick about the mechanisms behind this. So pay attention because this is really cool and something that's unique to each of these medications compared to the other stimulants out there. Let's first start with Concerta. So this medication has an osmotic release, oral system, or Oros for short. Okay, and if you break down the various components of the tablet itself, you'll see that its outer layer consists of an immediate release methylphenidate overcoat. Now, what does this mean exactly? Well, what happens is that when you take Concerta, 22% of the total dose of the medication is released within the first hour it's taken. Then when looking further at the tablet, we see that there's a rate-controlled membrane that has laser-drilled holes in it. This covers the three inner compartments of the tablet, which consists of two drug compartments and one push compartment. The two drug compartments contain the other 78% of the remaining dose, and what we see is that when the medication is in your gut, the tablet will absorb water as it's being digested. The push compartment will take on this water and the contents within it will start to expand and increase the pressure within the tablet. This increase in pressure will then cause the medication in the two drug compartments to be released. to be pushed out of those laser-drilled holes at a controlled rate in your body. So overall, it's believed that this medication will last in your system around 10 to 12 hours on average, and a fun fact is that the medication shells don't get digested, so it's common to see them pop up in your poop, so don't be alarmed. Now let's talk about Vyvanse. Vyvanse is unique in that it has a lysine chemical bound to it, which makes it pharmacologically inactive, and it remains inactive until... After you take it orally and the enzymes in your body leave it off, right? Which then turns the medication into active dextroamphetamine. This is significant because it helps reduce potential abuse and diversion of this medication. Vyvanse is thought to last on average around 12-14 hours, and interestingly, amphetamine only makes up about 30% of Vyvanse, which means it's much less potent than straight dextro amphetamine. Therefore, when switching from one amphetamine product to Vyvanse, you typically have to double the dose to get the same effect. If you're looking for a way to keep track of all this information so that you can talk further about these medications with your doctor, I made a free PDF for you that covers all the main talking points, so make sure to download it. The link is in the description below. Okay, now let's dive into the side effects of these medications. According to the FDA medication labels, the five most common side effects of Concerta are decreased appetite, headaches, dry mouth, nausea, and insomnia. Where the top five for Vyvanse are decreased appetite, insomnia, upper abdominal pain, irritability, and vomiting. Out of all the side effects, the one that I'm asked about the most is decreased appetite and the effects on growth. So let's break these down further. What the Concerta label states is that consistently medicated children meaning they're receiving treatment for seven days per week throughout the year, have a temporary slowing in growth rate, and on average what we see over a three-year period is around two centimeters less in growth in regards to height and weight loss of around 2.7 kilograms or about six pounds. For Vyvanse, the label states that in a controlled trial of Vyvanse in children ages 6 through 12 years, mean weight loss from baseline after 4 weeks of therapy was around 0.9, 1.9, and 2.5 pounds respectively for patients receiving 30, 50, and 70 mg of Vyvanse. Basically, what this is saying is that the higher the dose, the more weight loss to be expected. Also, average weight loss was found to be a little higher for teenagers compared to children. Regardless which stimulant someone is on, especially when we're talking about children and teens, Weight and height should be measured at every single appointment, and growth charts should be tracked over time to make sure that growth isn't being significantly affected by medication treatment. Now, before we get into which medication is best, the other thing I want you to know about is the cost of these medications. Concerta is available in brand and generic versions, so if insurance coverage is an issue, this medication is more affordable. Vyvanse on the other hand is only available at this time as the brand version, so looking at good Rx. At the time of filming this video, a 30-day script of Concerta can be obtained for $44 at Hy-Vee, whereas Vyvanse is $353. Word on the street, though, is that Vyvanse is going to have a generic option available come 2023. Okay, so now for the big question. Which medication is best, Concerta or Vyvanse? Let's dive into the research and see what it has to say. The first study looking at Vyvanse vs. Concerta was published in the journal CNS Drugs in 2013. Children and teenagers aged 6-17 were randomized to receive either Vyvanse, Concerta, or placebo, and the results showed that Vyvanse had a statistically significant greater improvement in symptoms of ADHD than those receiving Concerta. There was another study in 2014 that indirectly compared Vyvanse, Stratera, which is a non-stimulant option for ADHD, and various formulations of methylphenidate, which included the long-acting versions such as Concerta. This meta-analysis included 32 different trials. and they found that for the treatment of ADHD in children and teens, there was a statistically significant better probability of response for Vyvanse compared to the other various formulations of methylphenidate and Stratera. Now the third study I want you to know about was published in Ciena's Drugs in 2017, and this was a head-to-head comparison of Vyvanse and Concerta in teens with ADHD. Again, Vyvanse was found to be superior to Concerta specifically when using a forced dose of 70 mg per day of Vyvanse and then 72 mg per day with Concerta. Now, what does this all mean? It means that studies conducted thus far have shown that both Vyvanse and Concerta are more effective than placebo in the treatment of ADHD. However, based on these results, Vyvanse might be the more effective treatment option when compared to Concerta. However, something to always take into consideration is treatment adherence. Meaning, we need to look not only at how effective a medication is, but also how well it's tolerated. The Journal of Medical Economics came out with a study in 2013 that compared the treatment adherence of Vyvanse and other ADHD medications, including Concerta. What this study found was that Concerta was better tolerated than Vyvanse, and then this was further supported by a 2018 study in Lancet that evaluated efficacy and tolerability of ADHD medications in kids, teens, and adults. And they suggested that when taking into account both variables, methylphenidate, aka medications like Concerta, right, should be used first line in kids and teens, and that amphetamine-based products should be preferred in adults. Now, if you're looking to learn more about either of these medications, make sure to click that next video.