Methylphenidate is considered the first medication approved for the treatment of the condition known as “hyperactivity” in the 1960s. As attention-deficit/hyperactivity disorder gained more mainstream attention in the 1990s, the number of diagnoses continued to skyrocket, increasing the demand for new treatments. By the year 1996, mixed amphetamine salts (i.e. Adderall) were approved for the treatment of ADHD; this further expanded the treatment market.
Mixed amphetamine salts attained mainstream popularity, and eventually surpassed methylphenidate as the most popular treatment. In 2000, the company Janssen Pharmaceuticals had engineered an improvement over standard “immediate-release” forms of methylphenidate. Their newly engineered drug Concerta was known to provide long-lasting relief for up to 12 hours, nearly tripling the duration of effect compared to immediate-release formats.
Nearly 8 years after Concerta had established itself as an effective ADHD medication, Shire Pharmaceuticals released the drug Vyvanse. Vyvanse was created as an improvement over mixed amphetamine salts (Adderall) in that it was a prodrug and provided a longer-lasting effect for nearly 14 hours. Although both Concerta and Vyvanse are similar in that they are psychostimulants, there are subtle differences between the two worth knowing.
Concerta vs. Vyvanse Comparison Chart
Below is a chart comparing Concerta with Vyvanse. While both have commonalities in that they are psychostimulants used to treat ADHD, their secondary approved uses differ, they have different active ingredients, and slight variations in their duration of effect.
|Approved uses||ADHD. Narcolepsy.||ADHD. Binge eating disorder.|
|Formats||ER (Extended-release)||Capsules (Extended release)|
|Dosages||ER: 18 mg/27 mg/36 mg/54 mg||30 mg/50 mg/70 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. It also acts as a 5HT1A receptor agonist.||As an inactive prodrug it is broken down in the body by enzymes to dextroamphetamine and l-lysine. It then acts as a TAAR1 agonist and VMAT2 inhibitor to release dopamine along with norepinephrine from storage sites and inhibits reuptake of these neurotransmitters.|
|Half life||3.5 hours||10 to 13 hours|
|Common side effects||Appetite loss. Dizziness. Headache. Insomnia. Nausea. Nervousness. Vomiting. Weight loss.||Abdominal pain. Appetite loss. Dizziness. Dry mouth. Headache. Insomnia. Irritability. Nausea. Nervousness. Sweating. Weight loss.|
|Date approved||August (2000)||February 23 (2007)|
|Effect duration||ER: 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.||Excessive daytime sleepiness. Cognitive symptoms of schizophrenia. Treatment-resistant depression.|
Concerta vs. Vyvanse: What’s the difference?
The most prominent difference between Concerta and Vyvanse is that Vyvanse is a prodrug, meaning it is inactive until metabolized by the body. Upon ingestion of Vyvanse, it is broken down by enzymes into the amino acid l-lysine and the drug dextroamphetamine. The dextroamphetamine then provides symptomatic relief from ADHD for up to 14 hours.
Concerta is unique in that it delivers an effect for up to 12 hours and the drug is distributed differently than most other long-acting drugs. Approximately 22% of the methylphenidate is delivered immediately, whereas the remaining 78% is released gradually for sustained symptomatic relief for up to 12 hours. Concerta is a methylphenidate-based drug, whereas Vyvanse is effective as a result of dextroamphetamine.
The methylphenidate within Concerta has been involved in more investigational uses than the lisdexamfetamine within Vyvanse. Concerta has a significantly shorter elimination half-life by comparison and a different manufacturer. Concerta is approved to treat narcolepsy – Vyvanse isn’t, but Vyvanse is approved for binge eating disorder – Concerta isn’t.
Both Concerta and Vyvanse are regarded as “Schedule II” controlled-substances, meaning they have a high potential for abuse and may be habit-forming. It is common for users to become psychologically dependent on these substances in order to function. Some people may use them as a means to perform well at school or work, and without them they cannot function.
Upon comparison, Concerta may have slightly more abuse potential due to the fact that it can be crushed and insufflated (i.e. snorted), whereas Vyvanse cannot. While it is considered difficult to crush Concerta, many users still do this to attain the more potent and faster-acting dopaminergic “high.” Vyvanse must be taken orally and metabolized to get any effect, making it less appealing to those attempting to abuse it.
Furthermore, the effects of Vyvanse are not usually immediate, sometimes taking up to 2 hours before the drug “kicks in.” That said, taking high doses of either of these drugs can result in a temporary psychological euphoria as a result of high concentrations of dopamine release. Frequent abuse may result in a condition known as “stimulant psychosis,” which stems from abnormally high dopamine levels.
Others may become physically dependent on these drugs, using them with the intent of losing weight. Many people use Vyvanse for weight loss, and it is approved for the related condition of binge eating disorder. Both Concerta and Vyvanse tend to reduce appetite, speed metabolism, and increase energy for working out.
Those who are overweight may be drawn to these medications as a fast-track weight loss solution and may become physically dependent upon the drug to maintain a certain physique. The fact that both these substances have a high abuse potential, they are non-refillable, and to attain a prescription, a patient must have a physical copy of a doctor’s signature.
Cost: Which is more expensive?
Those that don’t have top-notch insurance or are paying for their prescriptions out-of-pocket often want to know the cheapest medication to treat ADHD. If your doctor wants you to try either Concerta or Vyvanse, one may be preferable over the other if your budget is limited. Due to the fact that Vyvanse is a newer drug, it is not yet sold as a generic (lisdexamfetamine) – making the cost relatively expensive.
If we’re comparing “brand name” Concerta to “brand name” Vyvanse, the cost for Concerta is actually a bit more expensive for a 30 day supply. A typical 30 day supply of Concerta costs between $260 and $300 at most pharmacies; the greater the dose, the higher the cost. Those planning on purchasing Vyvanse will end up paying approximately $250 for a 30 day supply.
By comparison, the brand name Concerta is more expensive than Vyvanse. However, if we take into account the fact that Concerta is sold as a generic (methylphenidate ER), the price is cheaper than Vyvanse. Generic Concerta (methylphenidate ER) can be attained at a rate between $100 and $170 for a 30 day supply. This means that generic Concerta (methylphenidate ER) is the cheapest option, followed by Vyvanse, and the most expensive option remains brand name Concerta.
Dosage & Formats
Concerta is engineered as an OROS (osmotically controlled-release oral-delivery system) drug with a composition of 22% immediate-release methylphenidate and 78% gradual-release methylphenidate. This means that the drug starts working within minutes of administration, and should continue to elicit an effect for nearly 12 hours. Concerta is manufactured in four dosing options including: 18 mg, 27 mg, 36 mg, and 54 mg.
By comparison, Vyvanse is manufactured in capsule format as a prodrug, meaning it is biologically inactive until metabolized. The Vyvanse (lisdexamfetamine) powder gets broken down by the body, and metabolized into l-lysine and dextroamphetamine. The fact that the body needs to metabolize the drug before it becomes active means that it takes nearly 2 hours for the drug to “kick in” and the effect can last for up to 14 hours.
Vyvanse is manufactured in doses of 30 mg, 50 mg, and 70 mg – meaning it has one less dosing increment than Concerta. Although Vyvanse may only come in three dosing options, the capsules can be easily opened and powder can be poured onto food (e.g. yogurt) to attain less of the desired dose. Concerta cannot be cut and therefore users may have a more difficult time with titrating upwards or downwards compared to Vyvanse.
Efficacy: Which drug is more effective?
Most people comparing Concerta with Vyvanse are trying to determine whether one drug is superior in efficacy to the other. Both substances were approved for the treatment of ADHD, and are considered significantly more effective than a placebo in randomized, double-blind studies. Concerta elicits an effect for 12 hours, and Vyvanse elicits an effect for nearly 14 hours, meaning it is effective for a longer time-span than Concerta.
Concerta is faster-acting compared to Vyvanse due to the fact that 22% of its methylphenidate is immediately released. Since no head-to-head comparison studies have been conducted, it is impossible to conclude with any type of conviction that one drug is more effective than the other. Dosage equivalency calculations suggest that 36 mg Concerta is equivalent to 25 mg Vyvanse.
This suggests that lower doses of Vyvanse are likely more potent than higher doses of Concerta. In any regard, the efficacy of these drugs is most often based on the individual and subjective interpretations. One person may find that their ADHD responds better to Concerta, another may find that Vyvanse works better, and a third person may not respond well to either drug.
Comparing the active ingredient of each “methylphenidate” with “dextroamphetamine” some would argue that dextroamphetamine is the more potent option. This is based off of studies from the late 1990s/early 2000s suggesting that Adderall (75% dextroamphetamine / 25% levoamphetamine) is twice as potent as Ritalin (methylphenidate). It remains unclear as to whether the dextroamphetamine derived from Vyvanse is superior to the methylphenidate derived from Concerta.
- 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 of Concerta and Vyvanse are similar in that they both affect the neurotransmitters dopamine and norepinephrine. Furthermore they both elicit a stimulatory effect that improves attention span and reduces hyperactivity. The specific mechanisms of action for each drug are a direct result of their respective formulations and ingredient composition.
Concerta is comprised of methylphenidate, which functions as a catecholamine reuptake inhibitor, specifically inhibiting dopamine and norepinephrine. The inhibition of dopamine and norepinephrine leads to greater extracellular concentrations of these neurotransmitters. Concerta is believed to act as a “pure uptake inhibitor” without additional presynaptic activity.
Concerta capsules are comprised of an osmotically controlled-release oral-delivery system (OROS) which delivers 22% of the methylphenidate immediately (lasting 4 hours), and 78% gradually over the course of the following 8 hours. Due to the fact that Vyvanse is a prodrug, the active ingredient (lisdexamfetamine) remains inactive until metabolized by the body.
Once metabolized, the drug is converted into l-lysine (an amino acid) and dextroamphetamine. The dextroamphetamine inhibits reuptake of dopamine and norepinephrine, but unlike the methylphenidate within Concerta, elicits further presynaptic activity. The dextroamphetamine derived from Vyvanse stimulates presynaptic release of dopamine and norepinephrine from presynaptic neurons.
- Source: http://jad.sagepub.com/content/3/4/200.refs
From a medical perspective, both Concerta and Vyvanse are regarded as first-line treatment options for ADHD. They differ in secondary approvals in that Concerta attained approval for the treatment of narcolepsy, whereas Vyvanse attained approval for the treatment of binge eating disorder. Both drugs are considered effective antidepressant augmentation strategies in cases of refractory depression.
Historically, methylphenidate (within Concerta) was investigated for the treatment of aggression, bipolar disorder, criminality, lethargy, obesity, and postural orthostatic tachycardia syndrome (POTS). Although Concerta specifically may not have been investigated for all of these conditions, its active ingredient was. Vyvanse has been investigated for the treatment of excessive daytime sleepiness and cognitive impairment associated with schizophrenia.
As of 2015, Vyvanse has emerged as the most popular prescription for ADHD. As of 2013, both Concerta and Vyvanse were regarded as being among the top 20 psychiatric drugs. There were an estimated 9.8 million prescriptions for Vyvanse, and an estimated 8.8 million prescriptions for Concerta. This meant that they were in close competition as being the most popular “brand name” ADHD meds on the market.
Only generic Adderall (mixed amphetamine salts) was considered more popular than Concerta or Vyvanse. Data collected for number of most prescribed psychiatric drugs on a monthly basis (June 2013 to July 2014), suggests that Vyvanse was prescribed over 10 million times, yet Concerta didn’t even make the list. Runner-ups to Vyvanse included: Focalin XR (2.8 million prescriptions) and Strattera (2.3 million prescriptions).
This suggests that Vyvanse has continued to gain momentum, in part due to the fact that it is still not available as a generic. Furthermore many doctors prefer Vyvanse due to its longer-lasting effect and the fact that it is a prodrug, which means it must be taken orally (rather than getting snorted). Many people view Vyvanse as an improvement over Adderall, which is why it has attained more popularity than Concerta.
The side effects resulting from Concerta and Vyvanse are thought to be relatively similar due to the fact that they have similar mechanisms of action. Common side effects associated with both drugs include: appetite loss, dizziness, headache, insomnia, nausea, nervousness, and weight loss. Children and adolescents using either drug may experience weight loss, and tend to experience temporary stunting of growth.
This temporarily stunted growth as a result of psychostimulant usage isn’t thought to affect final adult height. A majority of side effects from these drugs are a direct result of dopamine and norepinephrine reuptake inhibition. It could be theorized that additional presynaptic activity of Vyvanse and its increased potency may result in more severe and/or a greater number of side effects than Concerta.
That said, most side effects can be chalked up to individual sensitivities to the active ingredients and dosing. Those taking a higher dose will likely have more side effects than someone taking the minimal effective dose. There is significant variation in regards to side effects based on individual physiology; one person may exhibit fewer side effects with Concerta and another may exhibit fewer with Vyvanse.
Individuals that take either Concerta or Vyvanse for an extended-term (e.g. years) will likely have a difficult time coping with discontinuation symptoms. Discontinuation symptoms are generally severe due to the fact that these substances are highly potent, and artificially increase dopamine. The brain becomes reliant upon these drugs to receive its dopamine fix, which reduces ADHD symptoms and enhances cognition.
Over time, Concerta and Vyvanse use up dopamine stores in the brain and downregulate receptors. This leads a person to experience low dopamine upon withdrawal, and reduced receptor density. Ultimately symptoms emerge including: excessive sleepiness, depression, fatigue, impaired concentration, and psychomotor slowing.
Due to the fact that endogenous production of dopamine is low as a result of substance dependence, these symptoms may last for weeks, months, or even longer. Neither drug should be regarded as more “difficult” than the other to discontinue. Difficulty of withdrawal is usually a result of dosing, term of usage, and whether an individual was abusing the drug.
There are numerous anecdotal accounts of both Concerta withdrawal and Vyvanse withdrawal. Concerta may present more withdrawal difficulties than Vyvanse due to the fact that the doses jump by 9 mg or 18 mg – making downward titrations more difficult. Vyvanse only is manufactured in 3 dosing options, but the powder can be emptied and measured to ensure a gradual downward titration.
Similarities (Recap): Concerta vs. Vyvanse
Listed below are some commonalities shared between Concerta and Vyvanse.
- Abuse potential: Each of these drugs is regarded as having a high potential for abuse.
- Drug type: Both drugs are classified as psychostimulants, increasing concentrations of stimulatory neurotransmitters.
- Duration of effect: Concerta is thought to deliver an effect spanning nearly 12 hours, but Vyvanse is thought to remain effective for up to 14 hours. Concerta is believed to “kick in” quicker and Vyvanse takes nearly 2 hours to produce an effect.
- Efficacy: Neither drug should be regarded as clinically superior than the other for the treatment of ADHD.
- Legal status: These medications are considered legal to possess with a prescription. They are classified as “Schedule II” drugs, meaning they are illegal to possess without a prescription. Prescriptions for both drugs are considered non-refillable.
- Mechanisms of action: The active ingredients of each drug functions by inhibiting reuptake of dopamine and norepinephrine. There may be subtle differences in presynaptic activity, but these differences aren’t regarded as being substantial.
- Medical uses: Each drug was initially approved for the treatment of attention-deficit/hyperactivity disorder (ADHD).
- Side effects: Commonly noted side effects from these drugs include: appetite loss, headache, dizziness, nausea, and nervousness.
- Withdrawal: Discontinuing either drug is considered challenging for long-term users or those that have abused either substance. Withdrawal may persist for months until the brain endogenously increases dopamine production.
Differences (Recap): Concerta vs. Vvyanse
Listed below is a recap of some notable differences between Concerta and Vyvanse.
- Cost: Buying brand name Concerta costs between $260 and $300, whereas brand name Vyvanse costs $250 for a 30 day supply. Generic Concerta can be purchased for $100 to $170 for a 30 day supply.
- Format: Concerta is manufactured using OROS (osmotic controlled-release oral-delivery system), delivering 22% immediate-release methylphenidate and 78% delayed-release methylphenidate. Vyvanse is manufactured in prodrug capsules, meaning it must be fully absorbed and metabolized before the drug delivers an effect.
- Generic availability: Concerta is sold under the generic “methylphenidate ER,” but Vyvanse is not yet generic.
- Half-life: The estimated elimination half-life of Concerta is 3.5 hours, whereas the elimination half-life of Vyvanse is an estimated 14 hours.
- Ingredients: The active ingredient in Concerta is methylphenidate, and the active ingredient in Vyvanse is dextroamphetamine (as a result of metabolized lisdexamfetamine).
- Investigational uses: The methylphenidate within Concerta has been investigated for the treatment of aggression and criminality, whereas Vyvanse has not. Vyvanse has been investigated for cognitive impairment associated with schizophrenia, whereas Concerta has not.
- Manufacturers: Concerta is manufactured by Janssen Pharmaceuticals and Vyvanse is manufactured by Shire Pharmaceuticals.
- Popularity: In 2013, there were nearly 1 million more prescriptions for Vyvanse than Concerta. Between 2013 and 2014, there were significantly more prescriptions for Vyvanse by comparison. Concerta seems to have fallen by the wayside in terms of popularity and has been largely replaced by Focalin.
Which drug is better for ADHD? Concerta vs. Vyvanse.
Everyone wants to know whether Concerta is better than Vyvanse or vice-versa. The truth is that neither drug can be objectively considered better than the other. Most people will need to test out each drug for themselves to determine whether they respond better to one drug over the other. Some people will find that these drugs work equally well, while others will report that they experience significant improvement with one substance compared to the other.
Many doctors prefer to prescribe Vyvanse due to the fact that it is a prodrug, making it less subject to abuse. Some people respond better to methylphenidate-based drugs than amphetamine salts and find that they provide a “cleaner” focus; vice-versa also applies. If you respond better to amphetamine salts – Vyvanse may be a better option, whereas if you respond better to methylphenidate – Concerta may be the better option.
As a result of differences in FDA-approved uses, Concerta may be better for treating narcolepsy than Vyvanse, but Vyvanse may be better at treating binge eating disorder than Concerta. It may take some time for you to determine which drug provides you with more superior symptomatic relief compared to the other.
Which drug do you prefer: Concerta or Vyvanse?
If you’ve been through the ringer of ADHD meds and have had the opportunity to try both Concerta and Vyvanse, leave a comment letting everyone know which drug you prefer. Mention whether you found one drug to be: longer-lasting, more potent, effective, or have fewer side effects. Mention any “pros” and “cons” you can think of associated with your usage of Concerta or Vyvanse.