Attention deficit hyperactivity disorder (ADHD) and binge eating disorder can be challenging conditions to manage. Fortunately, medications like Concerta and Vyvanse are available to help alleviate symptoms. Both drugs are central nervous system (CNS) stimulants approved by the Food and Drug Administration (FDA) to treat ADHD. While they share similarities, they also have distinct differences, including their potential effects on weight loss. This article delves into a comprehensive comparison of Concerta and Vyvanse, covering their mechanisms of action, efficacy, side effects, and other important considerations.
Introduction to Concerta and Vyvanse
Concerta (methylphenidate hydrochloride) and Vyvanse (lisdexamfetamine dimesylate) are stimulant medications used to treat ADHD in adults and children. They are classified as Schedule II controlled substances by the Drug Enforcement Administration (DEA) due to their potential for abuse and dependence. As stimulants, both medications affect neurotransmitters in the brain, primarily dopamine and norepinephrine. These neurotransmitters play a crucial role in focus, attention, and impulse control. By influencing these chemicals, Concerta and Vyvanse can help improve ADHD symptoms.
Concerta
Concerta is available in both brand-name and generic formulations, with methylphenidate (extended-release) as its active ingredient. It is primarily used to treat ADHD in adults and children ages 6 years and older.
Vyvanse
Vyvanse, also available in brand-name and generic forms, contains lisdexamfetamine as its active ingredient. Lisdexamfetamine is a prodrug, meaning it is inactive until converted into dextroamphetamine in the body. This conversion process occurs in the gastrointestinal tract and liver. Vyvanse is used to treat ADHD in adults and children ages 6 years and older. It is also approved for treating moderate to severe binge eating disorders in adults. The prodrug mechanism of Vyvanse is believed to lower its abuse potential compared to other stimulants.
How Concerta and Vyvanse Work
Both Concerta and Vyvanse act as central nervous system (CNS) stimulants, but they have different mechanisms and delivery systems.
Read also: Weight Loss on ADHD Meds
Concerta's Delivery System
Concerta utilizes an osmotic-controlled release oral delivery system (OROS). This system releases methylphenidate in a controlled manner throughout the day, providing a steady dose of the drug. About 22% of the medication is released immediately, while the remaining 78% is released gradually over time. This controlled delivery helps maintain consistent symptom control and reduces the need for multiple daily doses. Concerta tablets should be swallowed whole and not crushed, split, or chewed to keep the OROS pump delivery system intact.
Vyvanse as a Prodrug
Vyvanse is a prodrug, meaning it is inactive until metabolized by the body. Once ingested, enzymes break down lisdexamfetamine into dextroamphetamine and the amino acid l-lysine. The dextroamphetamine then provides relief from ADHD symptoms. This unique mechanism results in a smoother onset and offset of effects, potentially reducing rebound symptoms experienced with immediate-release formulations.
Dosage and Administration
The dosage and administration of Concerta and Vyvanse vary depending on individual needs and response to treatment.
Concerta Dosage
Concerta is typically taken once daily in the morning. The dosage depends on age and response to treatment, with available strengths including 18, 27, 36, and 54 mg. A doctor usually starts with the lowest possible dosage and increases it only if necessary.
Vyvanse Dosage
Vyvanse is also taken once daily in the morning. For people 6 years or older with ADHD, the starting dosage is typically 30 mg. If this initial dosage does not provide adequate symptom relief, the doctor may raise the daily dose by 10 or 20 mg each week. The maximum daily dose of Vyvanse for ADHD is 70 mg. Vyvanse is available as a capsule or chewable tablet, offering flexibility for those who have difficulty swallowing pills.
Read also: Side Effects of Concerta: Weight Changes
Efficacy of Concerta vs. Vyvanse
While both Concerta and Vyvanse have undergone clinical trials to establish their safety and efficacy, limited data directly compares the two drugs. However, some studies have explored their relative effectiveness.
Comparative Studies
In 2014, the manufacturer of Vyvanse released results from two studies comparing Concerta and Vyvanse efficacy in patients aged 13-17 years with ADHD. The first study assessed the change from baseline at week six in the Attention Deficit Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) total score. Patients taking Vyvanse experienced a slightly larger reduction in the score (25.4 point reduction) compared to those taking Concerta (22.1-point reduction) or placebo (17-point reduction).
The second study treated patients for eight weeks. Patients taking Vyvanse had a 25.6-point reduction in ADHD-RS-IV total score, while those taking Concerta had a 23.5-point reduction, and the placebo group had a 13.4-point reduction. Although Vyvanse was slightly more effective in these studies, the research focused solely on patients aged 13-17 years.
Side Effects
Both Concerta and Vyvanse can cause side effects, although the specific effects and their severity may vary.
Common Side Effects of Concerta
Common side effects of Concerta include:
Read also: Differences in ADHD Meds
- Decreased appetite
- Headache
- Dry mouth
- Nausea
- Trouble sleeping
- Anxiety
- Dizziness
- Weight loss
- Irritability
- Increased sweating
Common Side Effects of Vyvanse
Common side effects of Vyvanse include:
- Reduced appetite
- Weight loss
- Anxiety
- Dizziness
- Dry mouth
- Irritability
- Insomnia
- Nausea
- Vomiting
- Stomach pain
Serious Side Effects
Both Concerta and Vyvanse carry a risk of serious side effects, including:
- Abuse, misuse, and addiction
- Increased blood pressure and heart rate
- Mental (psychiatric) problems
- Slowing of growth (height and weight) in children
- Circulation problems in fingers and toes
- New or worsening tics or Tourette's syndrome
- Serotonin Syndrome
Precautions and Warnings
Before taking Concerta or Vyvanse, it's crucial to inform your healthcare provider about your medical history, symptoms, and any other medications you are taking.
Contraindications
Concerta and Vyvanse are contraindicated in patients with:
- Known allergy to the medication or any of its ingredients
- Current use of monoamine oxidase inhibitors (MAOIs) or use within the past two weeks
Black Box Warning
Both Concerta and Vyvanse have a black box warning from the FDA due to the risk of abuse and dependence. Healthcare providers will evaluate patients for the risk of abuse before prescribing these medications and monitor for signs of abuse during treatment.
Other Warnings
- Stimulant medications have caused sudden death in rare cases in children and adolescents with certain serious heart problems.
- Sudden death, stroke, and heart attack have also occurred in adults.
- Concerta and Vyvanse should be used with caution in people with high blood pressure or heart problems, as they can increase blood pressure and heart rate.
- Prolonged and painful erection (priapism) has occurred with stimulants.
- Children taking stimulants may experience a temporarily slowed growth rate.
- When taking Concerta or Vyvanse, there is a risk of serotonin syndrome, a life-threatening condition caused by a buildup of excess serotonin.
Drug Interactions
Concerta and Vyvanse can interact with several medications, potentially leading to adverse effects.
Interactions to Avoid
- Concerta or Vyvanse should not be taken with monoamine oxidase inhibitors (MAOIs) because the combination could cause a hypertensive crisis (dangerously high blood pressure).
- Concerta or Vyvanse should be used cautiously with other medications that increase serotonin, such as antidepressants, triptans for migraine, or the cough suppressant dextromethorphan, due to the risk of serotonin syndrome.
Concerta and Vyvanse for Weight Loss
While both medications are not FDA-approved for weight loss, appetite loss and increased metabolic rate are common side effects. The potential side effects of taking either of these medications for weight loss appear to outweigh the potential benefits. If you’re taking Concerta or Vyvanse for an approved condition, you should report any changes in weight to your doctor.
Weight Loss Considerations
Weight loss is a common concern with both medications, although the mechanisms and management strategies may differ. Concerta often causes appetite suppression as a primary mechanism leading to weight loss. The medication’s dopamine reuptake inhibition affects appetite-regulating centers in the brain. Vyvanse typically produces more pronounced appetite suppression due to its amphetamine base and extended duration of action.
Managing Weight Loss
Managing weight loss associated with Concerta or Vyvanse requires proactive strategies.
- Nutritional counseling and meal planning can help maximize caloric intake during periods of reduced appetite.
- Some people benefit from taking medication after breakfast to preserve their morning appetite.
- Consuming a high-calorie breakfast before taking medication can be helpful.
- Evening snacks and dietary supplements help maintain adequate caloric intake.
- Regular weight monitoring ensures early identification of concerning trends.
Cost and Coverage
The cost and insurance coverage for Concerta and Vyvanse can vary.
Insurance Coverage
Brand-name versions of Concerta or Vyvanse are not typically covered by insurance plans. If they are covered, they may have higher out-of-pocket costs. Medicare prescription plans also do not typically cover brand-name Concerta or Vyvanse. Instead, insurance and Medicare prescription plans are more likely to cover generic forms of Concerta or Vyvanse, although coverage will vary by plan.
Out-of-Pocket Costs
The out-of-pocket cost for 30 brand-name Concerta 36 mg tablets is about $643. The cost of Vyvanse is generally higher, as it is only available in brand-name form.
Alternatives to Concerta and Vyvanse
If Concerta and Vyvanse are not suitable options, several alternative ADHD medications are available.
Stimulant Alternatives
Other stimulant medications for ADHD include:
- Adderall (amphetamine and dextroamphetamine)
- Biphentin (methylphenidate)
- Ritalin (methylphenidate)
- Daytrana (methylphenidate)
- Focalin (dexmethylphenidate)
Nonstimulant Alternatives
Nonstimulant ADHD medications are another option. These medications include:
- Atomoxetine (Strattera)
- Guanfacine (Intuniv)
Although antidepressants are not specifically approved to treat ADHD, they can sometimes help manage symptoms.
Which Medication Is Right for You?
Deciding whether Concerta or Vyvanse is the better choice depends on individual factors, symptom patterns, and treatment goals. Both medications effectively manage ADHD symptoms, but their different mechanisms may make one more suitable than the other for different people. Concerta may be preferable for individuals who respond well to methylphenidate-based treatments or those who have experienced adverse effects with amphetamine-based medications. Vyvanse may be more appropriate for individuals concerned about abuse potential or those requiring extended symptom control.
Factors to Consider
- Individual response: Some people achieve optimal symptom control with Concerta, while others respond better to Vyvanse's amphetamine-based mechanism.
- Side effects: Consider the potential side effects of each medication and how they might affect you.
- Abuse potential: If you have concerns about abuse potential, Vyvanse's prodrug design may be a better option.
- Duration of action: Consider how long you need the medication to be effective each day. Concerta typically provides 12 hours of symptom control, while Vyvanse can last for 12 to 14 hours.
- Formulation: Vyvanse is available in chewable form, which may be more suitable for children or people who have difficulty swallowing pills.