The pharmaceutical market is saturated with drugs intended to treat ADHD. The number of different options is often helpful for patients that may not respond to the first drug that they try. Although there are a variety of different options, the two most popular formulations are those containing mixed amphetamine salts and those containing methylphenidate.
Focalin is a drug comprised of the ingredient “dexmethylphenidate” (d-threo-methylphenidate) or D-TMP. It contains solely the dextrorotatory (right-handed) stereoisomer of methylphenidate and some consider its potency to be approximately double to that of methylphenidate. Adderall is comprised of mixed amphetamine salts, namely 75% dextroamphetamine and 25% levoamphetamine.
The original Focalin approved in 2001 elicited an effect lasting approximately 4 to 6 hours. It wasn’t until 2008 that Novartis Pharmaceuticals engineered an extended-release (XR) version, designed to provide a sustained psychostimulant effect for up to 12 hours. The immediate-release (IR) form of Focalin is comparable to Adderall IR, and the extended-release (XR) Focalin is comparable to Adderall XR.
Focalin vs. Adderall: Comparison Chart
Below are some general comparisons between Focalin and Adderall. As you can tell, both are psychostimulant medications primarily utilized for the treatment of ADHD. Their specific mechanisms of action may be subject to slight differences due to each having unique active ingredients.
|Approved uses||ADHD||ADHD / narcolepsy|
|Ingredients||Dexmethylphenidate||Mixed Amphetamine Salts: 75% Dextroamphetamine + 25% Levoamphetamine|
|Formats||IR (Immediate release) or XR (Extended release)||IR (Immediate release) or XR (Extended release)|
|Dosages||IR: 2.5 mg/5 mg/10 mg or XR: 5 mg/10 mg/15 mg/20 mg/25 mg/30 mg/35 mg/40 mg||IR: 5 mg/7.5 mg/10 mg/12.5 mg/15 mg/20 mg/30 mg or XR: 5 mg/10 mg/15 mg/20 mg/25 mg/30 mg|
|Manufacturer||Novartis Pharmaceuticals||Shire Pharmaceuticals|
|Legal Status||Schedule II (US)||Schedule II (US)|
|Mechanism of action||Functions by inhibiting reuptake of catecholamines and considered a norepinephrine dopamine reuptake inhibitor (NDRI). It inhibits dopamine and norepinephrine transporters – increasing extracellular levels of each.||Functions by increasing levels and inhibiting reuptake of stimulatory neurotransmitters such as dopamine and norepinephrine. It acts as a TAAR1 agonist and VMAT2 inhibitor.|
|Half life||2 to 4.5 hours||11 to 13 hours|
|Common side effects||Appetite loss. Dizziness. Insomnia. Nervousness. Stomach aches. Weight loss.||Abdominal pain. Appetite loss. Diarrhea. Dizziness. Dry Mouth. Fever. Headache. Insomnia. Irritability. Nausea. Nervousness. Vomiting. Weight loss.|
|Date approved||IR = November (2001) / XR = May (2005)||February 13 (1996)|
|Effect duration||IR: 4 to 6 hours/XR: 12 hours||IR: 4 to 6 hours/XR: 12 hours|
|Investigational uses||Narcolepsy. Treatment-resistant depression.||Treatment-resistant depression (Read: Adderall for depression).|
Focalin vs. Adderall: What’s the difference?
The primary difference between Focalin and Adderall is that Focalin is comprised of the dextrorotatory stereoisomer of methylphenidate. Adderall isn’t derived from methylphenidate, rather it is a unique formulation of mixed amphetamine salts (75% dextroamphetamine / 25% levoamphetamine). Both drugs are effective for the treatment of ADHD and are considered first-line options.
Adderall has gotten approval to treat narcolepsy, whereas Focalin is not approved for narcolepsy. That said, there is some evidence to suggest that Focalin XR may be an effective option. The mechanisms of action are slightly different due to the active ingredients. Both Focalin and Adderall are thought to inhibit reuptake of dopamine and norepinephrine, but Adderall also triggers presynaptic release of these neurotransmitters from presynaptic neurons.
Both of these drugs are classified as “Schedule II” controlled-substances, meaning they have a high potential for abuse and are habit forming. Many individuals may notice that they become psychologically dependent upon them after moderate or long-term use. This is partially due to the fact that the reuptake inhibition of dopamine is capable of inducing a psychological euphoria, especially when ingested at high doses.
This means that individuals may resort to taking increasingly higher (supratherapeutic) doses in order to achieve a stimulatory euphoria. The problem with abuse is that tolerance is quickly developed, leading an individual to require increasingly greater amounts of the drug to achieve the same effect. When the drug is stopped, an abuser may have a difficult time functioning with suboptimal levels of dopamine and receptor downregulation.
Due to the fact that Focalin is thought to be less popular than Adderall, it probably isn’t abused to the same extent. Adderall remains a popular drug among college students for studying, passing tests, and even weight loss. (Read: Adderall for weight loss). Furthermore, many partygoers often resort to snorting Adderall as a means of achieving a rapidly-induced euphoria.
The abuse of either one of these drugs may induce a temporary “stimulant psychosis” characterized by hallucinations, delusions, and disorganized behavior. This is largely a result of dopaminergic imbalances that often correct themselves upon discontinuation of either medication and/or cessation of abuse. Focalin may receive less mainstream press than Adderall, but its potential for abuse shouldn’t be discounted.
Cost: Which is most expensive?
Assuming you don’t have an insurance plan that covers your ADHD medications, you may only be able to afford the drug that costs the least. Drug cost is often a distinguishing factor between whether someone chooses to try Focalin vs. Adderall. From a “brand name” perspective, both Focalin and Adderall are relatively expensive for a 30 day supply.
If you want to purchase standard “brand name” immediate-release Focalin, it’ll cost between $45 and $90 for a 30 day supply (60 total pills). If you don’t take two pills per day and only need 30 immediate-release pills, it’ll cost between $25 and $50. The lower doses (i.e. 2.5 mg) usually cost less money than the higher doses (i.e. 10 mg).
By comparison, Adderall IR (immediate-release) costs approximately $310 at most pharmacies for a 30 day supply. This means that the less costly option of the two IR versions is clearly Focalin. Those looking to purchase Focalin XR (extended-release) will end up paying between $270 and $310 for a 30 day supply.
Once again, there is a relationship between strength of dosage and price you’ll pay. By comparison, Adderall XR (extended-release) costs just over $220 for a 30 day supply. This means that the “brand name” Adderall XR is significantly cheaper than Focalin XR.
Generic Focalin IR (dexmethylphenidate) can be attained within the range of $20 to $50 for a monthly supply of 60 pills. Generic Adderall IR (mixed amphetamine salts) costs between $30 and $50, making the immediate-release formulations similar in cost. Generic Focalin XR (dexmethylphenidate ER) costs between $100 and $200, whereas generic Adderall XR costs between $75 and $150 for a 30 day supply.
The costs are subject to significant variation based on the specific “brand name” or generic version of either drug that you need. The generic versions of each are cheaper than the brand name counterparts, and the immediate-release generics are nearly identically priced. The extended-release version of Adderall is slightly cheaper in generic form than the extended-release format of Focalin.
Dosage & Formats
Focalin is manufactured in the formats of immediate-release (IR) and extended-release (XR). Adderall is also manufactured in immediate-release (IR) and extended-release (XR) formats. The duration of effect for both the IR and XR versions of each drug are considered to be nearly identical at 4 to 6 hours (immediate-release) and up to 12 hours (extended-release).
In the regards to formats, the drugs are very similar. There are three dosing options for Focalin IR at 2.5 mg, 5 mg, and 10 mg. By comparison, there are significantly more formulations for Adderall IR at 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg. Those taking Adderall IR may have an easier time titrating dosages than those taking Focalin IR due to the fact that they have more options and move up in increments of 2.5 mg for a longer span.
Focalin XR is manufactured in more dosing options than Adderall XR, although each increases in 5 mg increments from 5 mg to 30 mg. Focalin XR offers a 35 mg and a 40 mg dose – which Adderall XR does not. That said, some would argue that manufacturing Adderall XR at a greater dose than 30 mg is unnecessary due to its heightened potency.
Efficacy: Which drug is more effective?
Everyone taking medications to treat ADHD wants to know whether the drug they’re taking is considered the most effective option. Both Focalin and Adderall are considered highly potent options for treating symptoms of ADHD. Each of these drugs is regarded as being significantly more effective than a placebo in double-blind, randomized studies; this is why they were approved by the FDA.
Stimulant equivalency charts suggest that 10 mg of Focalin XR packs nearly the same punch as 10 mg of Adderall XR, meaning the strengths of dosages may be nearly identical. Similarly, 5 mg of standard (immediate-release) Focalin is thought to be an approximate equivalent to 5 mg of standard (immediate-release) Adderall. Some studies from the late 1990s/early 2000s have suggested that Adderall may be more effective than methylphenidate for treating ADHD.
These studies suggested that a single dose of Adderall may produce the same effect as 2 doses of methylphenidate. That said, Focalin is not methylphenidate – it is d-threo-methylphenidate, the more potent of methylphenidates two isomers. A 2004 publication suggested that d-threo-methylphenidate may be up to twice as potent as standard methylphenidate and was significantly more effective in improving ADHD symptoms.
This means that both Focalin and Adderall should be nearly identical in terms of potency. Individual variation will often dictate whether a person prefers Focalin over Adderall or vice-versa. In a 2011 study comparing Adderall XR to Focalin XR, it was found that Adderall reduced symptoms by 80% and Focalin reduced symptoms by 79%; nearly equal in terms of efficacy.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/10405498
- Source: http://www.ncbi.nlm.nih.gov/pubmed/15502601
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243461/
Mechanisms of action
The respective mechanisms of action for Focalin and Adderall are similar in that they both provide psychostimulation. Both drugs inhibit the reuptake of dopamine and norepinephrine, thus increasing their extracellular levels. Focalin contains the d-enantiomer of methylphenidate, and functions by inhibiting dopamine and norepinephrine reuptake into the presynaptic neuron, allowing neurotransmitters to be released into the extraneuronal space.
The specific therapeutic mechanisms of Focalin aren’t fully understood, but it is regarded as functioning similar to methylphenidate. The mixed amphetamine salts (dextroamphetamine and levoamphetamine) within Adderall inhibit the reuptake of dopamine and norepinephrine. These mixed amphetamine salts elicit further presynaptic activity by triggering release of these neurotransmitters.
In other words, Adderall is not only acting to inhibit their reuptake, but it is stimulating presynaptic release. The delivery for both Focalin and Adderall is regarded as being nearly identical – especially for the extended-release versions. Focalin XR is engineered with a Spheroidal Oral Drug Absorption System, meaning each capsule contains 50% immediate-release beads and 50% delayed-release beads.
Adderall XR is similar in that 50% of the dose is immediate-release and the remaining 50% is delayed-release. The delivery of these drugs is similar and the effect of each has two “peaks” or bimodal peaks. The IR-portion will reach an initial “peak” and the delayed-beads will reach a second “peak” in terms of efficacy.
From a medical standpoint, Focalin is only approved for the treatment of attention-deficit/hyperactivity disorder (ADHD). Adderall is also approved for the treatment of ADHD, but is also FDA approved for the treatment of narcolepsy. Due to the similarities of these two drugs, some speculate that Focalin may also prove to be an effective option for narcolepsy.
In fact, one investigative use for Focalin XR is the treatment of narcolepsy. Both Focalin and Adderall are thought to be effective antidepressant augmentation strategies among individuals with refractory depression. Some doctors may favor Adderall over Focalin due to the fact that Adderall has been on the market since 1996 and has been involved in more studies.
Although methylphenidate predates Adderall, the specific d-enantiomer of methylphenidate (Focalin) hasn’t been involved in as extensive of research. Some studies speculate that it is nearly double the potency to standard methylphenidate. Unlike Focalin, Adderall has been investigated for cognitive rehabilitation in stroke patients and some psychiatrists may be more likely to test Adderall for anxiety disorders as a counterintuitive treatment.
As of 2012, reports suggested that generic Adderall (mixed amphetamine salts) was the most prescribed psychostimulant medication. In 2012, Adderall was estimated to have held over 35% of the entire market-share for ADHD. Within the past couple years, its popularity has decline somewhat in part due to the promotion of Vyvanse, a drug developed by the same company (Shire Pharmaceuticals) as Adderall.
The patent for Adderall has expired, so Shire devised Vyvanse as a more appealing prodrug by comparison. Monthly prescriptions for Focalin XR increased from 2013 to 2014 to nearly 3 million, making Focalin XR more popular from a “brand name” perspective. From a generic perspective, Adderall clearly is more relevant and popular than Focalin.
The side effect profile of Focalin is very similar to that of Adderall. Exact side effects are subject to significant individual variation, but most people taking psychostimulants experience similar side effects. Commonly reported side effects from both drugs include: appetite loss, dizziness, insomnia, nervousness, stomach aches, and weight loss.
One study determined that 43% of Focalin and Adderall users had individual preferences for one drug over the other. These preferences may have been partially influenced by the severity and total number of unwanted side effects experienced during treatment. Due to the fact that both Focalin and Adderall are considered nearly equal in terms of potency, and have similar mechanisms of action, the side effects should be similar.
Some individuals may find that their physiology responds better to mixed amphetamine salts, while others may notice that they respond better to dexmethylphenidate. Those with a sensitivity to methylphenidate may respond worse to dexmethylphenidate than they would mixed amphetamine salts. Subjective, anecdotal reports have suggested that Focalin produces less jitters and a cleaner effect than Adderall.
Regardless of whether you are discontinuing Focalin or Adderall, it will likely be difficult. Although withdrawal is influenced by individual factors such as dosage and time span over which the drug was taken, the sheer potency of Focalin and Adderall can lead to psychological dependence. Individuals that have been taking either medication for a long-term may find that they are unable to function without the drug.
Withdrawal symptoms associated with Focalin and Adderall often include: excessive fatigue, lethargy, sleepiness, and psychomotor slowing. In other words, you feel physically sluggish and as if your ADHD symptoms have amplified ten-fold. In fact, many people report that after they discontinue stimulant treatment, their ADHD symptoms are significantly worse than prior to taking either drug.
This is due to the fact that over time, the brain expects to receive the dopamine and norepinephrine boost that it has been getting from Focalin or Adderall. Dopamine receptors are downregulated as a result of excess stimulation, which results in tolerance. During withdrawal a person must endure low dopamine levels for awhile until their brain reorganizes itself and increases endogenous production of dopamine and receptors.
Neither drug should be considered “tougher” than the other to discontinue due to the fact that they are equal in potency. Individual physiology and subjectivity often plays a role in determining whether Adderall withdrawal or Focalin withdrawal is more severe or protracted than the other.
Similarities (Recap): Focalin vs. Adderall
As you can see, Focalin and Adderall are considered similar drugs in that they are both psychostimulants and considered relatively equal in terms of potency. Their IR and XR formats are thought to produce the same duration of effect.
- Abuse potential: Both Focalin and Adderall are considered “Schedule II” controlled-substances in the United States, meaning they have a high potential for abuse. They have similar mechanisms of action and are considered highly potent psychostimulants.
- ADHD: Another commonality shared between these two drugs is that they’re both used primarily for the treatment of attention-deficit hyperactivity disorder. Neither drug is considered superior to the other – they are each first-line pharmaceutical options.
- Cost: Adderall XR is less expensive than Focalin XR, but the immediate-release Adderall is significantly more expensive than immediate-release Focalin. The generic versions of both IR and XR versions are similarly priced for a 30 day supply.
- Drug type: Each drug is considered a psychostimulant with similar mechanisms of action.
- Duration of effect: The duration of effect for standard Focalin and Adderall is estimated to be within the range of 4 to 6 hours. The XR formats of each medication is estimated to elicit an effect for up to 12 hours.
- Efficacy: Neither drug should be regarded as having superior efficacy over the other. In a head-to-head study, it was found that Adderall XR reduced ADHD symptoms by 80% and Focalin XR did so by 79% – the difference is insignificant.
- Formats: Both drugs are manufactured in “immediate-release” (IR) and “extended-release” (XR) formats.
- Generic availability: Generic Focalin is sold under “dexmethylphenidate” and generic Adderall is sold under “mixed amphetamine salts.”
- Interactions: Both drugs are thought to have similar contraindications. For more information on specific drugs that interact with either Focalin or Adderall, talk to a medical professional.
- Legal status: These drugs are classified as “Schedule II” controlled-substances in the United States. This means that they are available only with a signed doctor’s prescription and that they’re non-refillable.
- Manufacturers: Focalin is manufactured by Novartis Pharmaceuticals and Adderall is manufactured by Shire Pharmaceuticals.
- Mechanisms of action: The mechanisms of action associated with Focalin and Adderall are thought to be similar in regards to how they affect neurotransmission. Both inhibit reuptake of dopamine and norepinephrine, which reduces ADHD symptoms. Subtle differences in mechanisms are a result of ingredient composition.
- Withdrawal: Discontinuation from Focalin and Adderall is considered difficult, especially for long-term users, those taking high dosages, or those that have abused either drug. Differences in perceived difficulty of discontinuation should be regarded as subjective.
- Side effects: The side effect profiles of both drugs are considered similar. This is a result of similarities in mechanisms of action and the fact that both are psychostimulants. Weight loss, appetite suppression, dizziness, and nervousness are commonly reported with both drugs.
Differences (Recap): Focalin vs. Adderall
The most notable difference between Focalin and Adderall is the active ingredient in each. Focalin consists of dexmethylphenidate whereas Adderall consists of 75% dextroamphetamine / 25% levoamphetamine.
- Half-life: The elimination half-life of Focalin is estimated to be 2 to 4.5 hours, whereas Adderall has a much longer elimination half-life, ranging from 11 to 13 hours.
- Ingredients: Focalin is formulated with dexmethylphenidate (d-threo-methylphenidate) and Adderall contains 3/4 dextroamphetamine salts 1/4 levoamphetamine salts.
- Investigational uses: Both substances have been used on an off-label investigational basis as an adjunct option in the treatment of refractory depression. However, they differ in that Adderall has been tested among stroke rehab patients and Focalin has been investigated for narcolepsy.
- Medical uses: Though both drugs are approved to treat ADHD, Adderall is also approved to treat narcolepsy.
- Popularity: Adderall (mixed amphetamine salts) remains the more popular name in the psychostimulant world than Focalin (dexmethylphenidate). Evidence suggests that generic Adderall is prescribed significantly more than Focalin.
Which drug is better for ADHD? Focalin vs. Adderall.
Neither drug should be considered better than the other for treating ADHD. One comparison study conducted in children found that these medications were nearly identical in terms of ADHD symptom reduction. Adderall XR yielded an 80% reduction in symptoms and Focalin XR yielded a 79% reduction in symptoms at the same doses.
Nearly 43% of study participants were noted as having a preference for one drug over the other. These preferences are likely stem from physiological reactions to the active ingredients. Some people may find that their physiology reacts better to mixed amphetamine salts, whereas others may find that dexmethylphenidate produces a more favorable effect.
Both medications are estimated as being twice as potent as methylphenidate and on psychostimulant equivalency charts, 10 mg of Adderall is thought to equal 10 mg of Focalin. Determining whether one is more effective or favorable over the other is a matter of individuality and should be considered subjective.
Which drug do you prefer: Focalin or Adderall?
If you’ve taken both Focalin and Adderall, share whether you prefer one over the other in the comments section. Mention whether you found one to be more effective than the other, which drug produced less side effects, and which provided superior ADHD symptom reduction. Also share any thoughts in regards to whether you felt as if one drug was more potent than the other.