Concerta vs. Adderall: Comparison

Concerta is a medication that was approved in August 2000 for the treatment of ADHD (attention-deficit hyperactivity disorder) in children.  Since its initial approval as an ADHD medication for children, it has attained FDA approval for usage in adolescents (2004) and adults (2008) with ADHD.  Although Concerta is technically a newer drug than Adderall, the active ingredient “methylphenidate” has been on the market for the treatment of hyperactivity since 1955.

Adderall wasn’t approved for the treatment of ADHD until 1996, but has become the single most prescribed pharmaceutical drug for attentional-deficits.  When comparing Concerta with Adderall, it is clear that Adderall is significantly more popular.  However, both drugs are classified as psychostimulants and their mechanisms of action each inhibit the reuptake of neurotransmitters like dopamine and norepinephrine.

Concerta vs. Adderall Comparison Chart

Below is a chart comparing the medication Concerta with Adderall.  As you can see, both are psychostimulants approved for the treatment of ADHD and narcolepsy, but the active ingredients differ as do their manufacturers.

	Concerta	Adderall
Drug type	Psychostimulant	Psychostimulant
Approved uses	ADHD. Narcolepsy.	ADHD. Narcolepsy.
Ingredients	Methylphenidate ER	Mixed Amphetamine Salts (~75% Dextroamphetamine & ~25% Levoamphetamine)
Formats	ER (Extended-release)	IR (Immediate release) or XR (Extended release)
Dosages	18 mg/27 mg/36 mg/54 mg	IR: 5 mg/7.5 mg/10 mg/12.5 mg/15 mg/20 mg/30 mg XR: 5 mg/10 mg/15 mg/20 mg/25 mg/30 mg
Manufacturer	Janssen Pharmaceuticals	Shire Pharmaceuticals
Legal status	Schedule II (US)	Schedule II (US)
Mechanism of action	Functions by inhibiting catecholamine reuptake - specifically as a Dopamine Reuptake Inhibitor (DRI). It blocks dopamine and norepinephrine transporters - increasing their extracellular concentrations. Also acts as a 5HT1A receptor agonist.	Functions by increasing levels and inhibiting reuptake of stimulatory neurotransmitters such as dopamine and norepinephrine. Acts as a TAAR1 agonist and VMAT2 inhibitor.
Generic version (?)	Yes.	Yes.
Half-Life	3.5 hours	11 to 13 hours
Common side effects	Appetite loss. Dizziness. Headache. Insomnia. Nausea. Nervousness. Vomiting. Weight loss.	Abdominal pain. Appetite loss. Diarrhea. Dizziness. Dry Mouth. Fever. Headache. Insomnia. Irritability. Nausea. Nervousness. Vomiting. Weight loss.
Duration of effect	12 hours	IR: 4 to 6 hours XR: ~12 hours
Investigational uses	Aggression. Bipolar disorder. Criminality. Lethargy. Obesity. Postural Orthostatic Tachycardia Syndrome (POTS). Treatment-resistant depression.	Treatment-resistant depression (Read:Adderall for depression).
Date approved	2000 (August)	1996 (February)

Concerta vs. Adderall: What’s the difference?

The chart above documents some general differences between Concerta and Adderall.  They are different in that Concerta was approved 4 years after Adderall, and initially was only recommended for usage in children.  However, it has since been approved for the treatment of ADHD in all ages.  The effect duration of Concerta and Adderall XR is similar, lasting an estimated 12 hours.

The half-life of each drug differs in that the half-life for Concerta is significantly shorter at 3.5 hours compared to Adderall at 11 to 13 hours.  This means that Concerta is excreted from your body at nearly three-fold the speed of Adderall.  The specific mechanisms of action differ slightly, leading some to prefer the effect of Adderall over Concerta and vice-versa.

Abuse Potential

The fact that Concerta and Adderall are classified as “Schedule II” controlled-substances indicates that they each have a high potential for abuse and dependence.  Individuals prescribed either of these drugs may find that they are habit forming and that tolerance is rapidly developed.  This rapid tolerance means that over time, the efficacy of a certain dose becomes less effective, leading the individual to take more of the drug to attain the desired effect.

Due to the fact that these medications release stimulatory neurotransmitters, it is possible for users to experience varying degrees of psychological euphoria.  This dopaminergic euphoria is part of what makes each of these substances appealing to partygoers.  Many partygoers use stimulants like Concerta and Adderall to reduce the drunkenness associated with drinking alcohol, to increase energy, and increase socialization.

Those abusing either of these drugs may resort to non-medically accepted methods of administration such as insufflation or injection.  For example, many people believe that snorting Adderall elicits a quicker and more potent “high” than oral consumption.  In addition to partiers abusing these drugs, students may also become dependent on their effects to attain desired academic results.

Even those attempting to lose weight may gravitate toward abusing stimulants. (Read: Using Adderall for weight loss). These non-approved uses for the drug often result in psychological dependence upon the drug for functioning.  Since Adderall is the more popular drug and elicits slightly more potent effects than Concerta, it is more often abused.

Cost: Which is more expensive?

Another important factor to consider when comparing Concerta and Adderall is the medication cost.  Not everyone has good insurance to cover the hundreds of dollars that are spent filling prescriptions.  The “brand name” version of Concerta costs between $260 and $300 for a 30 day supply – depending on the dosage; the greater the dosing, the greater the cost.

If you want to purchase brand name Adderall, you’ll end up paying different amounts based on the specific formulation you need.  If you need immediate-release Adderall, it’ll cost approximately $300 for a 30 day supply, making Adderall (IR) more expensive than lower doses of Concerta.  If you need to buy Adderall XR (extended-release), you’ll end up paying over $220 most places for a 30 day supply.

This actually makes Adderall XR the cheaper option when compared to Concerta.  Both formulations last approximately 12 hours, so don’t differ in duration of effect.  Upon comparison of generic Adderall (mixed amphetamine salts) to generic Concerta (methylphenidate ER), it seems as though generic Adderall is significantly cheaper.

Generic Concerta (methylphenidate ER) ranges in cost from $100 to $170 for a 30 day supply.  Generic Adderall IR ranges in cost from $30 to $50 for a 30 day supply – making the immediate-release format significantly cheaper.  The generic Adderall XR ranges in cost from $75 to $150 – making it cheaper than Concerta.

Dosage & Formats

Concerta is manufactured in just one dosing format of an “extended-release” (ER) version.  This allows methylphenidate (the active ingredient) to elicit a sustained effect over a 12-hour period.  Concerta is manufactured in dosage concentrations of 18 mg, 27 mg, 36 mg, and 54 mg.  This makes for significant “jumps” in dosing when a person wants to titrate upwards or downwards.

Some people may not like the degree to which Concerta doses are spread out (9 mg) and (18 mg).  Although another methylphenidate-based drug could be used to ease the titration process, they may not elicit the same 12-hour duration of effect as Concerta.  Adderall is more versatile in that it is manufactured in multiple formats (IR and XR) and a variety of doses.

The immediate-release (IR) version of Adderall is estimated to elicit an effect for approximately 4 to 6 hours, whereas the extended release (XR) version is estimated to work for 12 hours.  Like Adderall XR, Concerta is estimated to be effective for 12 hours.  Adderall may offer advantages in dosing options due to the fact that the IR version is manufactured in 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg.

The XR version is manufactured in 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg – providing options for a more gradual titration process compared to Concerta.  It is estimated that approximately 36 mg of Concerta is equivalent to 10 mg Adderall XR.  This means that a lower dose of Adderall is likely of greater strength than a higher dose of Concerta, but the distribution of Concerta is novel in that there are no “bimodal peaks.”

Efficacy: Which drug is more effective?

Those evaluating Concerta and Adderall as potential options for the treatment of ADHD or narcolepsy all want to know which one is more effective.  It is difficult to state that one drug is superior in efficacy to the other due to the fact that they both have gone through rigorous testing and were superior to a placebo in randomized, double-blind studies.  In most cases, the efficacy for each of these drugs is often a result of individual variation and subjective interpretation.

You may find that there are advantages and disadvantages associated with each drug.  One person may find that Adderall works better than Concerta, but another may find that Concerta produces a longer, smoother effect.  Many people complain of experiencing an “Adderall crash” when the effect wears off, but this “crash” may not be as prominent among Concerta users due to the drug’s novel delivery.

There is no definitive evidence that either drug is more effective than the other.  However if we are comparing the active ingredient of “methylphenidate” to Adderall (mixed amphetamine salts), some studies from the late 1990s/early 2000s suggest that Adderall may be slightly more effective.  That said, neither study compared Adderall to Concerta – a novel, extended-release formulation of methylphenidate, so it is unclear as to whether Adderall is marginally superior in terms of efficacy.

• Source: http://www.ncbi.nlm.nih.gov/pubmed/10405498
• Source: http://www.ncbi.nlm.nih.gov/pubmed/10802980

Mechanisms of action

The mechanisms of action for Concerta and Adderall are regarded as similar in that they are both stimulatory.  Each is known to inhibit the reuptake of dopamine and norepinephrine, which increases extracellular concentrations of these neurotransmitters.  Methylphenidate within Concerta is known to act as a “pure uptake inhibitor” with no further presynaptic activity.

Adderall contains mixed amphetamine salts (75% dextroamphetamine / 25% levoamphetamine) which trigger presynaptic release of dopamine and norepinephrine from presynaptic neurons. The delivery system for Concerta is referenced as “OROS” (osmotically controlled-release oral-delivery system).  This OROS delivery results in an immediate release of methylphenidate in the outer covering of the tablet, followed by an 8-hour release via osmotic pump.

Adderall XR is comprised of 50% delayed-release beads and 50% immediate-release beads.  This allows the user to receive an immediate effect from the drug and a sustained effect as the delayed-release beads are processed.  The delivery systems differ between Concerta and Adderall, resulting in some people favoring one over the other.

• Source: http://jad.sagepub.com/content/3/4/200.refs

Medical Uses

Medically speaking, Concerta and Adderall are both primarily used for the treatment of attention-deficit disorder.  They are also FDA approved to treat narcolepsy due to the fact that individuals with narcolepsy are prone to excessive daytime sleepiness.  Both medications are capable of providing a sustained stimulatory effect that enhances cognitive function and speeds up psychomotor activity.

Both are considered effective antidepressant augmentation strategies for those diagnosed with refractory depression.  In regards to off-label or investigational uses, they are thought to differ.  The active ingredient in Concerta (methylphenidate) has been investigated for the treatment of aggression, bipolar disorder, criminality, lethargy, obesity, and POTS (postural orthostatic tachycardia syndrome).

While the extended-release methylphenidate in the format of Concerta has not been specifically investigated for all of the aforementioned conditions, it should be thought to elicit similar effects (or possibly more sustained effects) compared to other methylphenidate formulations.  Adderall has been investigated for stroke rehabilitation, but evidence is unclear regarding whether it actually helps.  In some cases, each drug has been anecdotally tested as a counterintuitive treatment for anxiety disorders. (Read: Adderall for anxiety disorders).

Popularity

Collected data reveals that an estimated 38% of all psychostimulant prescriptions in 2013 were for Adderall.  Various methylphenidate-based prescriptions like Concerta accounted for 23% of the ADHD medication market-share.  Of the methylphenidate-based prescriptions, it is difficult to know precisely what percentage was specifically for Concerta.

For the year of 2014, estimates suggest that there were over 8.8 million prescriptions for Concerta.  Generic Adderall (mixed amphetamine salts) in immediate-release and extended-release formats were more popular when combined.  There were an estimated 12.8 million prescriptions for generic Adderall IR and nearly 8 million for Adderall XR.

Assuming “brand name” prescriptions are compared, Concerta ER was more popular than any brand name of Adderall.  This is due to the fact that the patent had expired for Adderall, making it more economical for individuals to purchase the generic versions.

Side Effects

The side effects that you’ll experience from Concerta and Adderall are subject to individual variation, but are likely similar.  Since both drugs increase activity in the central nervous system, they can often produce side effect such as appetite loss, anxiety, insomnia, weight loss, and irritability.  In addition to general common side effects, it is known that methylphenidate and mixed amphetamine salts may stunt growth.

The stunting of growth is considered temporary and ultimately should not affect an individual’s final adult height.  Due to the fact that both drugs increase concentrations of dopamine and norepinephrine via reuptake inhibition, they often suppress appetite, improve cognitive function, and long-term usage can cause weight loss.  In addition to children using these substances being shorter, they are also usually lighter – weighing less than non-medicated counterparts.

Withdrawal

Those taking Concerta and Adderall over a long-term may struggle with discontinuation.  Discontinuation is thought to be most severe among those who used these medications for a long-term (e.g. years) and at higher doses.  Since Adderall is considered the more potent of the two drugs, the highest daily dose of Adderall will likely present more discontinuation difficulties than the highest daily dose of Concerta.

Those using either drug on an “as-needed” basis or over a short-term are thought to have an easier time withdrawing.  There are many anecdotal reports that highlight the severity of both Concerta withdrawal and Adderall withdrawal.  Upon discontinuation, users generally experience a variety of symptoms including: fatigue, lethargy, sleepiness, and psychomotor slowing.

Furthermore, symptoms of ADHD may become more severe than they were prior to taking either of these drugs.  This is due to the fact that the brain becomes dependent upon the drug for everyday functioning.  Without the drug, a person’s brain is deprived of the stimulatory dopaminergic enhancement that they had been receiving, leading to temporary cognitive impairment.

In some cases withdrawal can last months (or years) depending on how long a person had been taking either drug.  From a “tapering” perspective, Adderall may be better suited for dosage reductions due to the fact that it is manufactured in a greater number of dosing increments.  Concerta doses jump by 9 mg or 18 mg – possibly making reduction adjustments more difficult.

Similarities (Recap): Concerta vs. Adderall

Below is a synopsis of similarities shared between Concerta and Adderall.

• Abuse potential: Each of these drugs has significant potential for abuse and dependence. They are habit-forming and can result in psychological euphoria when ingested at high doses.  Excess abuse of either substance may result in a state of “stimulant psychosis.”
• ADHD: Concerta and Adderall are both considered highly effective drugs for the treatment of attention-deficit/hyperactivity disorder.  They are prescribed as first-line treatments due to favorable side effect profiles and sustained efficacy.
• Duration of effect: Concerta is known to elicit an effect for approximately 12 hours. The extended-release Adderall is also thought to last approximately 12 hours, but some believe that it’s maximum duration of effect is 10 hours.
• Efficacy: Both drugs are thought to be relatively similar in terms of efficacy. However, Adderall is thought to be the more potent of the two drugs due to the fact that 10 mg of Adderall XR is equivalent to 36 mg of Concerta.
• Generic availability: Both substances are available in generic formulations. Concerta is available as “methylphenidate ER” and Adderall is available as “mixed amphetamine salts.”
• Interactions: While certain contraindications may differ between Concerta and Adderall, both drugs are known to interact with MAOIs, TCAs, antihypertensive drugs, and more. If you have any questions regarding interactions, talk to a medical professional or pharmacist.
• Legal status: These medications are considered legal (in the United States) when attained via prescription from a licensed medical professional. Without a prescription, they are considered illegal to possess.  All prescriptions for Concerta and Adderall are non-refillable.
• Psychostimulants: Each substance is classified as a “psychostimulant.” The mechanisms of action are relatively similar, with subtle differences resulting from ingredient composition.
• Medical uses: Concerta and Adderall have been approved for the treatment of ADHD (attention-deficit/hyperactivity disorder) as well as narcolepsy.
• Neurotransmission: Both drugs inhibit the reuptake of neurotransmitters like dopamine and norepinephrine. This leads to increases in extracellular levels, which promotes increased attention and reductions in hyperactivity.
• Side effects: These drugs carry very similar side effect profiles. General side effects tend to consist of: nervousness, anxiety, insomnia, weight loss, and appetite suppression.
• Withdrawal: Discontinuation from either medication is thought to be difficult. Various discontinuation symptoms include: psychomotor slowing, sleepiness, lethargy, and weight gain.  These effects are likely due to abnormally low dopamine levels as a result of dependence on these drugs.

Differences (Recap): Concerta vs. Adderall

Highlighted below are some notable differences between Concerta and Adderall.

The “brand name” version of Concerta costs between $260 and $300 for a 30 day supply – depending on the dosage; the greater the dosing, the greater the cost.

• Cost: Brand name immediate-release Adderall is more expensive than Concerta, whereas the extended-release Adderall is cheaper than Concerta for a 30 day supply. The generic formulations of Adderall are both cheaper than generic Concerta.
• Formats: Adderall is available in multiple formats (IR and XR) whereas Concerta is only available in one format (ER). The ER and XR formats are thought to be relatively similar, but the release mechanisms differ.  Concerta is thought to produce a smoother sustained release than Adderall.
• Half-life: Concerta has an estimated half-life of 3.5 hours, which is significantly shorter than that of Adderall at 11 to 13 hours.
• Ingredients: The active ingredient in Concerta is methylphenidate, whereas the active ingredient in Adderall is a mixture of amphetamine salts (75% dextroamphetamine / 25% levoamphetamine).
• Investigational uses: Methylphenidate has been used for the treatment of aggression and criminality, whereas Adderall has not. That said, the specific formulation of “Concerta” (methylphenidate ER) wasn’t used.  Adderall has been investigated as therapy for cognitive restoration in stroke patients.
• Manufacturers: Concerta is manufactured by Janssen Pharmaceuticals and Adderall is manufactured by Shire Pharmaceuticals.
• Popularity: From a generic perspective, Adderall (mixed amphetamine salts) are more popular than Concerta or methylphenidate. From a “brand name” perspective, Concerta ER is actually more popular than Adderall.  In part this is due to the fact that Adderall’s patent has expired.

Which drug is better for ADHD? Concerta vs. Adderall.

Those that are thinking about taking a psychostimulant medication to treat symptoms of ADHD or narcolepsy often research various medications in attempt to find the most effective drug with the least side effects.  However, it is important to note that responses to these medications are subject to significant individual variation.  One person may find that Concerta works better or has more favorable side effects than Adderall and vice-versa.

Upon comparison of active ingredients methylphenidate (Concerta) and mixed amphetamine salts (Adderall), some studies suggest that Adderall may be the more potent of the two formulas.  Concerta was initially designed for usage in children-only, but has since been approved for adolescents and adults with ADHD.  Equivalency reports indicate that 36 mg of Concerta is approximately as potent as 10 mg Adderall XR.

The formulated release of Concerta is considered novel in that there are no “bimodal peaks.”  Meaning there is a cleaner, more efficient release mechanism built-into the capsules.  Adderall XR is comprised of 50% immediate-release beads and 50% delayed-release beads – resulting in two “peaks” of release.  Many people find that one drug works slightly better for reducing their ADHD symptoms when compared to the other, but there is no scientific evidence proving one drug to be superior over the other.

Which drug do you prefer? Concerta vs. Adderall.

If you’ve tested both Concerta and Adderall for the treatment of ADHD, narcolepsy, or another off-label condition, feel free to share which drug you found to be more effective in the comments section below.  Did you find one drug to be more potent than the other?  Did you find one drug to provide you with a more sustained effect than the other?

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