If you or your child has been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), your healthcare provider may have mentioned trying ADHD medication as part of a comprehensive mental health treatment plan, including social, behavioral, and educational resources. Concerta and Ritalin are two stimulant ADHD medications approved by the United States Food and Drug Administration (FDA). Both prescription drugs are indicated for ADHD treatment. While both medications contain the same active ingredient, methylphenidate, they differ in their formulations and how they release the medication into the body. Understanding these differences, including their potential side effects such as weight loss, is crucial for making informed decisions about ADHD treatment.
What are Concerta and Ritalin?
Concerta and Ritalin are both classified as stimulant medications. Both are available in brand-name and generic forms. The generic name of Concerta is methylphenidate (extended-release). The generic name of Ritalin is methylphenidate and is an immediate-release tablet. Other forms of Ritalin are longer-acting. Ritalin-LA is a long-acting capsule (available in brand and generic), and Ritalin-SR (available in generic) is a long-acting tablet. Ritalin LA has a bi-modal release. Half of the methylphenidate is released immediately, and the second half is released later. A dose of Ritalin LA lasts for about eight to 10 hours.
How They Work
These medications work by blocking the reuptake of dopamine and norepinephrine in the brain. These neurotransmitters help regulate attention, focus, and impulse control. In individuals with ADHD, certain brain regions, such as the prefrontal cortex, basal ganglia, and anterior cingulate cortex, exhibit functional underactivity. The medications primarily target the prefrontal cortex, responsible for executive functions such as planning, decision-making, and impulse control. Clinical studies consistently show that methylphenidate improves core ADHD symptoms in approximately 70-80% of patients.
Forms and Dosages
Methylphenidate comes in several forms that are taken by mouth, including a capsule, chewable tablet, liquid, orally disintegrating tablet (ODT), and tablet. Methylphenidate also comes in short-acting (immediate-release) and long-acting (extended-release) forms.
Dosage forms and strengths include:
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- 2. 5 mg, 5 mg, 10 mg chewable tablets
- 20 mg, 30 mg, 40 mg extended-release chewable tablets
- 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 80 mg, 100 mg extended-release oral capsules
- 25 mg/5 mL (5 mg/mL) extended-release oral suspension
- 10 mg, 18 mg, 20 mg, 27 mg, 36 mg, 45 mg, 54 mg, 63 mg, 72 mg extended-release oral tablets
- 6 mg, 17.3 mg, 25.9 mg extended-release orally disintegrating tablets
- 5 mg/5 mL, 10 mg/5 mL oral solution
- 5 mg, 10 mg, 20 mg oral tablets
Methylphenidate is also available as a patch that is applied to the skin.
Duration of Action
Concerta lasts about 12 hours and is dosed once daily in the morning, so it may be a better choice for someone who has to focus for many hours and does not want to have to take additional doses of medication. In contrast, Ritalin is a short-acting medication. It typically lasts about 3 to 6 hours, depending on the individual and the dose.
Concerta offers a long-acting formulation of methylphenidate that may better suit individuals needing full-day symptom control. This extended-release medication uses osmotic-controlled release oral delivery system (OROS) technology to deliver methylphenidate consistently over approximately 12 hours. The medication’s unique design releases 22% of the dose immediately, while the remaining 78% is released gradually throughout the day.
Ritalin comes in immediate-release, sustained-release, and extended-release forms. Immediate-release Ritalin works quickly to relieve symptoms but wears off within a few hours, so you have to take it two or three times a day, depending on how you respond to Ritalin and your doctor’s instructions. If you only take one dose of immediate-release Ritalin, you likely won’t experience symptom relief all day long, as it lasts 2-4 hours. Ritalin LA (extended-release) is only taken once daily in the morning and will last you up to 8 hours, and Ritalin SR (sustained release) lasts 4-6 hours.
Indications and Usage
Concerta and Ritalin are both indicated for ADHD treatment in children ages 6 years and older, adolescents, and adults. Ritalin is also indicated for narcolepsy.
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Concerta vs. Ritalin: Key Differences
When comparing Concerta against Ritalin, remember that both drugs contain methylphenidate, so we are looking at the same drug. The difference lies in the way the drugs are dosed and how long they last.
Formulation and Release
The main differences between Ritalin and Concerta involve the formulations and how quickly the medication gets released into the body. Concerta is only available in extended-release form, so it works a bit more gradually and is long-acting. Ritalin works more quickly, but the effects are shorter-lasting, so you have to take two or three doses of it per day. However, extended-release Ritalin is available.
- Concerta: Contains a long-acting form of methylphenidate. It is designed to last for about 12 hours, so it is dosed once per day in the morning.
- Ritalin: Contains an immediate-release form of methylphenidate. It is generally taken two or three times daily because it is short-acting. Other forms of Ritalin are longer-acting.
Dosing Schedule
Concerta may be taken once a day, while Ritalin may be taken multiple times a day if you’re using the immediate-release.
- Ritalin: Ritalin needs to be taken 2 to 3 times per day. A typical schedule might include a dose in the morning, another around lunch, and possibly a third in the late afternoon.
- Concerta: Concerta is more convenient for many people because it’s taken once a day, usually in the morning.
Dosage Conversion
When transitioning from Ritalin to Concerta, clinicians follow established dose conversion guidelines. For instance, a patient taking 10 mg of Ritalin twice daily may be switched to 36 mg of Concerta once daily.
Side Effects of Concerta and Ritalin
Like all medications, Concerta and Ritalin come with possible side effects. Side effects from methylphenidate often disappear within a few weeks of starting the medication. However, for some people the side effects are severe enough to merit a cessation of the medication. The most common side effects with both Ritalin and Concerta include headache, stomach ache, loss of appetite, sleep issues, and nervousness. Less common side effects include dizziness, drowsiness, and anxiety.
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The most common side effects of methylphenidate are listed below. These side effects may vary depending on your age and the product you are taking. Tell your health care provider if you have any of these side effects that bother you.
- Decreased or loss of appetite
- Trouble sleeping
- Nausea and vomiting
- Upset stomach and stomach pain
- Weight loss
- Anxiety
- Dizziness
- Crankiness
- Mood swings and restlessness
- Fast heartbeat or a feeling of skipped heartbeats
- Increased blood pressure
- Headache
- Dry mouth
- Excessive sweating
There may be other side effects of methylphenidate that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine.
Serious Side Effects
While less common, the most serious side effects of methylphenidate are described below, along with what to do if they happen.
- Severe Allergic Reactions: Methylphenidate may cause allergic reactions, which can be serious. Stop taking methylphenidate and get help right away if you have any of the following symptoms of a serious allergic reaction:
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
- Risk of Misuse and Addiction: Misusing methylphenidate can lead to serious side effects, such as substance use problems, overdose, or death. Misuse means taking a medicine in a way other than how it was prescribed. Methylphenidate can also cause physical dependence, which means your body relies on the medicine. Take methylphenidate exactly as prescribed. Tell your health care provider if you feel that methylphenidate is not working. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms:
- Sudden confusion or feeling disoriented
- Feeling paranoid
- Suicidal thoughts or actions
- Seizures
- Trouble breathing
- Increased Blood Pressure and Heart Rate: Methylphenidate may increase your heart rate or blood pressure. Keep all appointments with your health care provider to check your blood pressure and heart rate before starting methylphenidate and during treatment. If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Also call your health care provider or get medical attention right away if you have chest pain, a fast or irregular heartbeat, or if you faint or feel your heartbeat more than usual.
- Behavior, Thought, or Mood Changes: Methylphenidate may cause or worsen psychotic-like behaviors, such as hallucinations or mania. People who already have a mental health condition, such as bipolar disorder, may be at higher risk of these side effects. Tell your health care provider right away if you have any of the following symptoms, or if you have been told by others you have these symptoms:
- Hearing, seeing, smelling, tasting, or otherwise perceiving things that others do not
- Delusional thoughts, such as false beliefs that you are being controlled
- Disorganized thoughts, such as jumping between topics or having a hard time focusing
- Sudden decline in self-care, such as personal hygiene or academic/work performance
- Aggressive behavior
- Very increased energy
- Significant trouble sleeping
- Racing, fast-paced thoughts
- Reckless behavior
- Unusually grand ideas
- Excessive happiness or crankiness
- Talking more or faster than usual
- Painful, Prolonged Erection (Priapism): Methylphenidate may cause an unwanted erection that is persistent, painful, and that may happen without sexual arousal. There can be permanent damage to the penis if priapism is not treated quickly. Stop taking methylphenidate and get emergency help if you have any of the following symptoms of priapism:
- Erection lasting for more than four hours
- Erection that is unrelated to sexual stimulation
- Painful or tender penis
- Blood Flow Problems: Methylphenidate may cause blood flow problems, including a condition called Raynaud's phenomenon, which happens when the blood vessels in your fingers and toes overreact and lead to low blood flow. Call your health care provider right away if you have any of the following symptoms:
- Fingers or toes feeling numb, cool, painful, or sensitive to cold
- Fingers or toes changing color from pale, to blue, to red
- Unexplained wounds on fingers or toes
- Slowed Growth in Children: Children taking methylphenidate may be at a higher risk of not gaining height and weight as expected. Keep all appointments with your health care provider to check your child’s height and weight before starting and during treatment with methylphenidate.
- Glaucoma: Methylphenidate may increase pressure inside the eye and cause or worsen glaucoma, which can lead to blindness. People who have problems with close-up vision (farsightedness) may be at higher risk. Tell your health care provider right away if you have any of the following symptoms of glaucoma:
- Changes in vision, including loss of vision
- Eye pain or redness
- Severe headache or vomiting
- Seeing bright, colorful circles around lights (vision halos)
- Tics: Methylphenidate may cause or worsen tics, which are sudden, repetitive movements or sounds that can be hard to control. Call your health care provider right away if you have any new or worsening tics.
- Seizures: Some people who have taken methylphenidate have reported having seizures. There are many types of seizures, and some of them are not easy to recognize. Stop taking methylphenidate and call your health care provider if you have any of the following signs that a seizure is happening or could happen:
- Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
- Stiffening of your arms and legs
- Feeling anxious, nervous, confused, or a sense of dread
- Feeling dizzy or lightheaded
- Falling or losing consciousness
Weight Loss as a Side Effect
One common side effect of both Concerta and Ritalin is weight loss. This is primarily due to the appetite-suppressing effects of methylphenidate.
- Decreased Appetite: Both medications can decrease appetite, leading to reduced food intake.
- Weight Loss: As a result of decreased appetite, weight loss is a common side effect, especially in children.
It’s important to monitor weight, especially in children, and ensure adequate nutrition.
Managing Side Effects
- Communicate with Your Doctor: Report any new or worsening side effects to your doctor.
- Monitor Weight: Regularly monitor weight, especially in children, to ensure healthy growth.
- Nutritional Support: Focus on a balanced diet to mitigate appetite suppression and ensure adequate nutrition.
- Adjust Dosage: Your doctor may adjust the dosage to minimize side effects while maintaining effectiveness.
Warnings and Precautions
Concerta and Ritalin both have a boxed warning, which is the strongest warning required by the FDA.
- Risk of Abuse and Dependence: Because of the risk of abuse or dependence, patients should be assessed for the risk of abuse before being prescribed Concerta or Ritalin.
- Cardiovascular Risks: Sudden death has been reported with stimulant medications, even at normal doses. This has happened in children/adolescents with certain heart abnormalities or problems. Sudden death, stroke, and heart attack have been reported in adults. These events are more likely to occur in adults with heart abnormalities or other heart problems. Blood pressure and/or heart rate may increase; patients should be monitored. Long-term exposure to ADHD medications was associated with an increased risk of hypertension and arterial disease. There's also a possible risk for sudden death in those with preexisting cardiac structural abnormalities.
- Psychiatric Risks: Stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients who have a preexisting psychotic disorder, such as bipolar disorder.
- Seizure Threshold: Stimulants may lower the seizure threshold in patients with a prior history of seizures.
- Priapism: Priapism (prolonged, painful erection) has occurred.
- Growth Monitoring: Children’s growth should be monitored during stimulant treatment.
- Visual Disturbances: Blurred vision may occur.
- Gastrointestinal Issues: Because of the shape of the Concerta tablet, patients with certain GI (gastrointestinal) problems should not take Concerta. The Concerta tablet should be swallowed whole and should not be chewed, split, or crushed. Ritalin LA capsules should be swallowed whole and should not be crushed, chewed, or divided. Or, you may open a Ritalin LA capsule and sprinkle the beads over one spoonful of applesauce and consume immediately.
Who Should Not Use Methylphenidate?
People who are allergic to any of the ingredients in methylphenidate products should not take it. Methylphenidate should not be taken while you are using certain other medicines. Before taking methylphenidate, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
Some forms of methylphenidate may contain sugar and should not be taken if you have a rare inherited condition that makes you unable to digest or absorb certain sugars. These conditions include hereditary fructose intolerance or glucose-galactose malabsorption.
Important Considerations Before Using Methylphenidate
- Do not take methylphenidate unless it has been prescribed to you by a health care provider. Take it as prescribed.
- Do not share methylphenidate with other people, even if they have the same condition as you. It may harm them.
- Keep methylphenidate out of the reach of children. Methylphenidate is a controlled substance because it can be misused or lead to dependence. Store methylphenidate in a safe place to protect it from theft. It is illegal to sell or give away this medicine.
- There are multiple forms of methylphenidate available. They may be used to treat different conditions and are taken in different ways. Read and follow the instructions for the product you have and make sure you understand how to prepare, take, and throw it away properly. If you have any questions, talk to your health care provider.
- Some methylphenidate capsules and tablets should not be chewed, cut, or crushed. After taking some methylphenidate tablets, you may notice a tablet shell in your poop. This is normal and does not mean the medicine did not work. The medicine is released in the body while the outer shell may stay intact. Talk with your health care provider if you have any questions.
- If you cannot swallow methylphenidate capsules, some capsules may be opened and sprinkled on a small amount of applesauce. Ask your pharmacist or other health care provider whether you can do this with your methylphenidate product and how to mix and swallow the mixture properly.
- If you are taking methylphenidate liquid, use an accurate measuring device to measure your dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Also, some forms of methylphenidate liquid must be shaken well before drawing up each dose. Ask your pharmacist what measuring device to use and whether your liquid must be shaken.
- Keep all appointments, including for bloodwork and heart checkups, before and during treatment with methylphenidate. This will help your health care provider make sure it is safe for you to use methylphenidate.
Drug Interactions
Concerta or Ritalin should not be taken with MAOIs (monoamine oxidase inhibitors) because the combination could cause a hypertensive (high blood pressure) crisis. Concerta or Ritalin should be separated by an MAOI by at least 14 days. Concerta or Ritalin should be used with caution with vasopressor agents (medications that are used to increase blood pressure) because of the potential for an increase in blood pressure.
Concerta or Ritalin may increase the levels of warfarin, certain anticonvulsants, and tricyclic or SSRI antidepressants. A dosage adjustment may be required if taken with Concerta or Ritalin. Concerta or Ritalin may decrease the effectiveness of diuretics or blood pressure medications.
The two most major drug interactions with Concerta and Ritalin are:
- Monoamine Oxidase Inhibitors (MAOIs): You have to be off of MAOIs for at least two weeks before starting methylphenidate to avoid the risk of dangerously high blood pressure.
- Antihypertensive drugs: Methylphenidate can both increase blood pressure and decrease the effectiveness of blood pressure medications.
Additionally, the following types of drugs may also interact with Concerta and Ritalin. In these cases, your doctor might need to adjust your dose of the other medication when you start taking methylphenidate.
- Anticoagulants (medications that prevent blood clots)
- Anticonvulsants (anti-seizure medications)
- Certain antidepressants (such as selective serotonin reuptake inhibitors or tricyclic antidepressants)
- Possibly antipsychotics
- Possibly mood stabilizers
This is not an exhaustive list of potential drug interactions. Make sure to tell your doctor about all prescription and non-prescription medications you take, including vitamins and supplements, so they can provide you with personalized medical advice and ensure that your prescriptions are safe for you.
Cost and Coverage
Coverage and cost comparison of Concerta vs. Concerta is not typically covered by Medicare Part D. It may be covered by insurance, typically in its generic form. The out-of-pocket cost for 30 Concerta 36 mg generic tablets can be more than $300. Ritalin is generally covered by Medicare Part D and may be covered by insurance, usually in the generic form. The out-of-pocket cost of 60 Ritalin 10 mg generic tablets is about $85. Ritalin is often less expensive, especially if you’re using the generic version (methylphenidate immediate-release). Concerta can be more expensive, especially the brand-name version. However, generic Concerta (methylphenidate extended-release) is available and may help reduce the cost. If cost is a concern, talk with your doctor or pharmacist.
Making the Right Choice
The most effective drug for you should be determined by your healthcare provider who can take into account your medical condition as well as your medical history and other medications you take that can interact with Concerta or Ritalin. Your healthcare provider will factor in your age, daily routine, symptom severity, comorbid conditions, and response to previous medications when helping you decide. Ultimately, your doctor will decide whether you should take Concerta or Ritalin. They will consider your symptoms, lifestyle, and personal preferences. Don’t forget that Concerta and Ritalin aren’t the only medications for ADHD. There are other stimulants (such as Adderall) and non-stimulant medications (such as Strattera) that might be a better match for you. Your doctor will make the call based on your medical history, symptoms, and diagnosis.
- Individual Needs: The choice depends on your individual needs and what your psychiatrist decides is a better fit for your ADHD symptoms.
- Dosage and Timing: Consider whether you prefer a once-daily extended-release medication (Concerta) or multiple doses of a shorter-acting medication (Ritalin).
- Side Effects: Be aware of potential side effects and discuss any concerns with your doctor.
- Cost and Coverage: Check your insurance coverage and consider the cost of each medication.
Questions to Ask Your Doctor
- What are the potential benefits and risks of Concerta and Ritalin for me?
- How should I monitor for side effects?
- What dosage is right for me?
- How often should I follow up with you?
- Are there any alternative treatments I should consider?
Additional Support for ADHD Treatment
Don’t underestimate the impact of therapy, nutrition, sleep, and lifestyle strategies in supporting ADHD treatment alongside medication.
- Therapy: Cognitive behavioral therapy (CBT) and other forms of therapy can help manage ADHD symptoms.
- Nutrition: A balanced diet can support overall health and medication effectiveness. Nutrition in the Management of ADHD: A Review of Recent Research.
- Sleep: Establishing a consistent sleep schedule can improve ADHD symptoms. The relationship between sleep and problem behaviors in children with attention-deficit/hyperactivity disorder.
- Lifestyle Strategies: Regular exercise and mindfulness practices can also be beneficial. A potential natural treatment for attention-deficit/hyperactivity disorder: evidence from a national study.