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Concerta vs Vyvanse

Comparing Concerta vs Vyvanse – which is better?
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Concerta and Vyvanse are both stimulants used for treatment of attention deficit hyperactivity disorder (ADHD) in children and adults. Both medications should be taken once daily. 

Concerta was approved by the FDA in 2000; while Vyvanse was released and approved by the FDA quite recently in 2007. 

Concerta contains methylphenidate, a potent drug connected to amphetamines, in its active form. Vyvanse contains lisdexamfetamine dimesylate. 

It is difficult to determine which is better of the two because some people respond better to Concerta, while some respond better to Vyvanse. In this article, we will discuss the basic similarities and differences between the two. 

Concerta

Concerta (methylphenidate extended-release tablets) is a central nervous system (CNS) stimulant. It is available in four tablet strength: 18mg yellow tablets, 27mg gray tablets, 36mg white tablets, and 54mg brownish-red tablets. 

Concerta uses osmotic pressure to deliver methylphenidate HCl at a controlled rate. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. 

The stimulant is indicated for use in children 6 years of age and older, adolescents, and adults up to the age of 65. 

It is a long-acting extended release tablet of methylphenidate. Methylphenidate is the same active agent in Ritalin, Methylin and Metadate.

Methylphenidate is formulated in Concerta as a kind of drug reservoir. Small amounts of this ingredient are released in a timely fashion at different times of the day.

The advantage of formulating Concerta in this way is that people diagnosed with ADHD can take their medication once daily. This promotes compliance and reduces the number of times doses are forgotten. 

Concerta should be used as a vital part of an ADHD treatment program, which includes educational, psychological, and social measures. 

Methylphenidate

Methylphenidate is a psychostimulant which is similar to but weaker than the opiate, cocaine. It also lasts longer in the body.

This drug molecule is approved for the treatment of 3 medical conditions: ADHD, narcolepsy and orthostatic tachycardia. However, it is also commonly used for treating obesity, depression and lethargy especially when other medications fail.

Methylphenidate works by blocking the monoamine transporters which reuptakes neurochemicals such as dopamine and norepinephrine.

In this way, it increases the levels of these two neurotransmitters in the brain leading to improvements in ADHD symptoms. Therefore, it increases alertness, attention and mental focus and reduces fatigue.

Dopamine and norepinephrine are normally taken up and removed at the nerve terminals. The drug molecule not only blocks this reuptake at those sites but also stimulates the release of dopamine and norepinephrine to nerve terminals.

These actions cause a quick rise in dopamine and norepinephrine levels at the synapse of the neurons in the brain. The combined effect is responsible for the quick onset and the long duration of action (4 hours) of the drug.

To extend the duration even further, methylphenidate is formulated as an extended release tablet which is known as Concerta.

The use of methylphenidate, a stimulant, in the treatment of hyperactivity is paradoxical. However, much like in homeopathy where small doses of poisons are used to treat the symptoms produced by large doses, methylphenidate produces opposite effects on the brain when compared to stronger stimulants.

Furthermore, different studies have shown that MRI (Magnetic Resonance Imaging) scans of ADHD and non-ADHD individuals point to differences in the brain regions responsible for mental focus, attention and impulse.

In addition, apart from increasing the levels of dopamine and norepinephrine in the neurons, methylphenidate also reduces the rate of glucose metabolism in the brain by as much as half.

Similaties between Concerta & Vyanse
  • Both are pyschostimulant drugs approved for treating ADHD
  • Both are meant for use in ADHD patients aged 6 and above
  • Both work by blocking the reuptake and stimulating the release of the neurotransmitters dopamine and norepinephrine

Vyvanse 

Vyvanse is a pro-drug that must be metabolized by the body and converted into an amphetamine, which is an active drug. 

Vyvanse is also a psychostimulant used in the treatment of ADHD. It contains L-lysine-D-amphetamine or Lisdexamphetamine dimesylate. This active ingredient is composed of dextroamphetamine and lysine.

Dextroamphetamine was coupled with lysine in Vyvanse for two reasons: to increase its duration of action and to make it difficult to abuse. The active part of this prodrug is the dextroamphetamine and it is released from the drug molecule by enzymes in the red blood cell.

Dextroamphetamine is only one form of amphetamine. The other form is levoamphetamine which is combined with the dextro form in Adderall. However, it is the dextro form included in Vyvanse which has the greater bioavailability and produces superior stimulation of the central nervous system.

Upon release, dextroamphetamine blocks the uptake of norepinephrine and dopamine at the synapses of neurons. It does this by substituting itself since it has a similar chemical structure.

At high doses, dextroamphetamine can even trigger the release of dopamine and norepinephrine in the brain leading to high concentration of both neurotransmitters.

These two mechanisms are responsible for the ability of Vyvanse to improve attention span and mental focus.

Vyvanse is available in 30mg white and orange capsules, 50mg white and blue capsules, and 70mg blue and orange capsules. 

The medications must be used in children 6 years of age and older, adolescents, and adults up to the age of 65. 

Differences between Concerta & Vyvanse
  • Vyvanse has a slow onset of action while Concerta is quick to act
  • The active ingredient in Vyvanse is a prodrug requiring conversion into an active form while Concerta already contains an active drug
  • Vyvanse is supplied in capsules while Concerta is formulated as tablets

Side Effects 

Concerta and Vyvanse have very similar side effects, such as insomnia, dry mouth, agitation, uneven heartbeats, anger, and loss of appetite. 

Not all ADHD patients who experience side effects from Concerta will experience similar side effects from Vyvanse. 

You must not take Concerta or Vyvanse, if you have used an MAO inhibitor, such as rasagiline (Azilect), isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), and selegiline (Eldepryl, Emsam), within the past 2 weeks. 

Risk of Abuse 

Both Concerta and Vyvanse are schedule II controlled substances and they have a high risk of abuse and dependence. 

Unlike Concerta, Vyvanse has a low potential of being abused by inhalation, since it is not transformed into an active drug unless taken orally. 

Are There Any Drug Interactions? 

Concerta might interact with some drugs such as clonidine (Catapres); warfarin (Coumadin); epinephrine (EpiPen); dobutamine (Dobutrex); and antidepressants. 

Vyvanse might interact with drugs such as ascorbic acid (vitamin C); K-Phos; ammonium chloride; lithium (Eskalith, Lithobid); blood pressure medications; and stomach acid reducers. 

Before taking Concerta or Vyvanse, you must tell your health care practitioner about all other medicines you use. 

Concerta must be swallowed whole. It can't be chewed or crushed and so it can be a trouble for children who can't swallow pills. Vyvanse can be opened and sprinkled on food, if your child can't swallow pills. 

For more information, read our articles Adderall vs Concerta, Ritalin vs Concerta, Adderall vs Vyvanse, and Adderall vs Strattera.

Next Article: Concerta vs Ritalin for Adults
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