Attention deficit hyperactivity disorder (ADHD) is a prevalent mental health condition affecting an estimated 4-5% of US adults and 6 million children. Medications like Concerta and Adderall are anti-ADHD agents that may help people with ADHD manage symptoms related to focus issues, attention, hyperactivity, and impulsivity. If you or a loved one are managing an ADHD diagnosis, you may wonder, what is the best treatment for your needs? You are not alone in asking this question or in facing some of the frustrations that come with finding the right treatment options. This article aims to provide a comprehensive comparison of Concerta and Adderall, two commonly prescribed medications for ADHD, to help individuals and their healthcare providers make informed decisions.
Similarities and Differences Between Concerta and Adderall
While the two are similar, Concerta and Adderall are not the same. Concerta and Adderall are similar in that they both work by increasing concentrations of norepinephrine and dopamine in the brain. Norepinephrine and dopamine are two vital neurotransmitters that help send messages to and from the different synapses within the brain. Increasing their levels may help improve symptoms of ADHD.
Similarities
- Approved for ADHD Treatment: Both Concerta and Adderall are approved to treat symptoms of ADHD like focus, hyperactivity, and impulsivity.
- Efficacy: They are roughly equally effective when studied across a general population. The CDC recommends a combination of behavioral therapy and medication for children aged 6 years and above with ADHD. Doctors usually recommend behavioral therapy for children under 6 years old with ADHD. The CDC also notes that behavioral therapy is just as effective as medication for children under 6. Additionally, it is unclear what the long-term effects of ADHD medications on young children are.
- Mechanism of Action: They are both central nervous system stimulants, influencing the levels of norepinephrine and dopamine in the brain. CNS (central nervous system) stimulants work in similar ways by blocking the reuptake of dopamine and norepinephrine in the brain. By blocking their reuptake, Concerta and Adderall can boost the effects of these neurotransmitters to help improve focus and attentiveness.
- Side Effects: They can both cause difficulty sleeping and decreases in appetite. Common side effects associated with Concerta and Adderall include headache, dry mouth, nausea, and insomnia. CNS stimulants like Concerta and Adderall are also known to decrease appetite.
Differences
- Active Ingredients: They have different active ingredients, which can be processed differently by the body. This leads to individual differences in how likely side effects will be and how well the medication may work.
- Concerta contains methylphenidate. Concerta is the brand name for methylphenidate extended-release tablets. It is FDA-approved to treat ADHD in adults and children aged 6 years and older. Methylphenidate (Concerta) is a Schedule II controlled substance. This CNS stimulant works by modifying the levels of norepinephrine and dopamine in the brain.
- Adderall contains a standardized mixture of various amphetamine salts. Adderall contains a combination of amphetamine and dextroamphetamine salts. It is approved to treat ADHD and narcolepsy in adults and children aged 3 years and older. Adderall contains a standardized mixture of various amphetamine salts. These include dextroamphetamine and levoamphetamine, among others. Adderall is also a central nervous system (CNS) stimulant as well as a Schedule II controlled substance. It contains four amphetamine salts: Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate.
- Release Mechanism: They offer different approaches for how the medication is released and how long it is likely to remain active each day.
- Concerta provides methylphenidate specifically in an extended-release formulation designed to keep the medication active for longer periods of time during the day. With its advanced trilayer formulation, Concerta starts working within one hour after the first tablet layer is dissolved. Concerta continues to gradually release its contents over the next 6-10 hours.
- Adderall is available in both regular-release tablets and extended-release capsules. The tablets release medication quickly and produce a sharper peak in drug levels. The extended-release capsules are intended to release the medication more slowly over the course of the day, similar to Concerta.
- Side Effect Profile: Although head-to-head studies are limited, Concerta appears more likely to cause upset stomach, and Adderall may be more likely to cause appetite loss and sleep disruption.
Understanding Concerta
Methylphenidate (Concerta) is a Schedule II controlled substance. This CNS stimulant works by modifying the levels of norepinephrine and dopamine in the brain.
Formulation and Release
Concerta provides methylphenidate specifically in an extended-release formulation designed to keep the medication active for longer periods of time during the day. Concerta has an advanced trilayer formulation that enables it to begin working within 1 hour of the tablet’s first layer dissolving. Concerta continues to gradually release its contents over the next 6-10 hours. According to CHADD’s National Resource Center on ADHD, Concerta can last between 10-12 hours.
Dosage
Concerta may be taken with or without food, but always as directed by your doctor. Tablets should be swallowed whole and not crushed, chewed, or divided. Most people take Concerta 1x/day in the morning. It is not recommended to take Concerta in the evening. Taking Concerta late in the day may interfere with your sleep.
Read also: Weight Loss on ADHD Meds
This anti-ADHD agent is available as an oral extended-release (ER) tablet in the following strengths: 18 mg, 27 mg, 36 mg and 54 mg. Most healthcare providers will increase the dosage of Concerta in 18 mg increments at weekly intervals for patients who exhibit the need for a higher dosage. It is not recommended to exceed 54 mg/day of Concerta for children and 72 mg/day for adolescents or adults.
Potential Side Effects
Some people who take Concerta may experience the following side effects: Increased nervousness, Anxiety, Dry mouth, Trouble sleeping/insomnia, Loss of appetite, Weight loss, Dizziness, Nausea/vomiting, Stomach pain, Sweating, Headaches and Empty tablet shell in stool. Concerta tends to cause higher rates of stomach upset and may increase depression symptoms. Although rare, some men and boys may also experience a prolonged erection for 4+ hours. Please consult a healthcare professional if you experience severe side effects from Concerta or if side effects last for more than several weeks.
Understanding Adderall
Adderall is also a central nervous system (CNS) stimulant as well as a Schedule II controlled substance. It contains four amphetamine salts: Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate.
Formulation and Release
Similar to Concerta, Adderall works by helping to balance out the chemicals within the brain to help with attention span, focus, behavioral problems, organization, and other challenges that may be associated with ADHD. Adderall is available in both regular-release tablets and extended-release capsules. The tablets release medication quickly and produce a sharper peak in drug levels. The extended-release capsules are intended to release the medication more slowly over the course of the day, similar to Concerta. Adderall tends to work even faster than Concerta, activating within 30 minutes to an hour of consumption.
Dosage
The dosage for Adderall and Adderall XR (extended-release version of Adderall) varies from person to person. Always take Adderall and Adderall XR only as prescribed by your doctor or pharmacist. It may be taken with or without food. Adderall tablets are available in the following doses: 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg and 30 mg. Adderall XR capsules are extended-release and comes in: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg and 30 mg.
Read also: Side Effects of Concerta: Weight Changes
Adderall tablets are typically taken 2-3x/day, with the first dose taken in the morning. Adderall XR capsules are intended to be taken once daily and in the morning. It is not advised to take Adderall in the evening as it is a stimulant, and taking it in the evening may interfere with sleep. Immediate-release Adderall may be taken multiple times during the day; this differs from Concerta, which should be taken just one time per day.
Those who have trouble swallowing tablets and/or capsules also have the option of opening the capsule, pouring its contents into a fluid (water is recommended) or applesauce/yogurt, and consuming it immediately.
Your doctor will prescribe the dose of Adderall or Adderall XR they feel is best based on your circumstances and a variety of factors. Do not exceed the recommended dose or frequency. Should you decide to discontinue taking Adderall, please do so under the care and supervision of a healthcare professional so the dose can be reduced in a safe manner. Discontinuing the use of Adderall suddenly may cause withdrawal symptoms, including loss of energy, cravings, panic attacks, tremors, body aches, mood swings, and short-term memory loss.
Potential Side Effects
Taking Adderall may come with the following side effects: Loss of appetite, Weight loss, Dry mouth, Upset stomach, nausea/vomiting, Headaches, Diarrhea, Fever, Nervousness, Trouble sleeping and Increased anxiety. Adderall tends to cause higher rates of insomnia and loss of appetite. Because Concerta and Adderall are stimulant medications, taking them also comes with a high risk of misuse/abuse and dependence. This could be in the form of physical dependence as well as psychological dependence.
Effectiveness of Stimulants for ADHD
Using stimulants like Adderall and Concerta for managing ADHD has been commonplace for decades, and prescribing rates have also grown over the years. This has led to some important questions related to the strength of the clinical studies supporting their use. A primary concern is related to the longer-term effects of stimulants, particularly because many trials only last for a period of six months or less, and people tend to take these medications for longer periods.
Read also: Weight Loss Effects: Concerta & Vyvanse
The primary question when considering any new therapy is whether the benefits of therapy will outweigh the risks. Comprehensive reviews of multiple trials help to pull together data from multiple sources, and these have been completed for both amphetamine salts and methylphenidate. These studies suggest that over the short term, both medications are effective but carry risks of side effects.
Abuse Potential
Both medications carry an abuse potential, which is why they are Schedule II controlled substances. There are no direct studies evaluating the potential for abuse between the two medications, so it’s difficult to confirm whether one may be more likely to be problematic. It’s worth noting that Adderall tablets provide a sharper peak in drug levels, making it potentially preferable for those intending to abuse stimulants.
Cost and Coverage
Both Adderall and Concerta are also available in generic form from multiple manufacturers. It’s likely your pharmacy will use a generic version of the medication unless the brand name is specifically requested by either you or your doctor. Generic medications are generally less expensive than their brand-name counterparts and will be more likely to be covered by insurance. Your out-of-pocket cost for the medication will depend heavily on your insurance coverage. The cost of medications without insurance coverage can vary widely between pharmacies.
A rough estimate of costs for a 30-day supply, assuming you use one dose per day, would be:
- Brand name Adderall XR: \$228
- Generic amphetamine salts ER: \$150
- Generic amphetamine salts regular release tablets: \$90
- Brand name Concerta: \$270
- Generic methylphenidate ER: \$210
Direct Comparisons in Studies
The studies that compare Concerta and Adderall directly are limited and date back to the 1990s. Crossover studies can be particularly helpful because these involve the same patient groups using both medications over time. Interestingly, while many of the overall findings did not find one medication to be clearly superior, some individuals were more likely to respond to one medication over the other. This highlights the need for solutions promoting personalized therapy.
Which Medication is Right for You?
Your healthcare provider will prescribe the anti-ADHD agent they feel is best for you based on your condition, symptoms, circumstances, and needs. Genetic testing for ADHD may also help determine the best anti-ADHD medication for you. There are several reasons to take Concerta vs Adderall, many of which come down to how your body may react to them.
The primary difference between Concerta and Adderall is that Concerta contains methylphenidate, and Adderall contains a combination of amphetamine salts and dextroamphetamine. When compared to Adderall, Concerta's effects tend to last longer and release more slowly over time.
The Role of Genetic Testing
The DNA found in our bodies contains valuable information that could help determine how we will respond to certain medications and treatment plans. ClarityX examines DNA to uncover this information and provide patients with detailed reports on how they may react to taking certain drugs. We look for variations with the cytochrome 450 enzymes (which metabolizes over 70% of drugs).
ClarityX offers two testing options with our pharmacogenetic testing:
- Mindwell test: This focuses on treatments for mental health conditions that include but are not limited to depression, anxiety, ADHD, OCD, and more.
- Max Rx test: This covers 31 therapeutic areas to test how an individual may respond to more than 265 medications.
Both the Mindwell and Max Rx tests may help determine how you will react to Concerta and Adderall. This could help you and your healthcare provider make more informed decisions about your treatment plan.
Additional Considerations
- Do not take Concerta if you have: motor tics, Tourette’s syndrome or a family history of Tourette’s syndrome.
- Do not take Adderall if you have: symptomatic cardiovascular disease, advanced arteriosclerosis, moderate to severe high blood pressure, hyperthyroidism or a history of drug addiction or misuse.