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Vyvanse vs Concerta
Introduction
For patients with attention deficit hyperactivity disorder (ADHD), certain drugs that influence the levels of neurotransmitters in the brain, which are tied to hyperactivity and impulse control, can assist in managing the symptoms. Vyvanse and Concerta are two such drugs that are prescribed for ADHD. They each impact different neurotransmitters in the brain, but both have effective outcomes in patients with ADHD. Vyvanse is a central nervous system (CNS) stimulant, also known as lisdexamfetamine, which primarily affects the levels of dopamine. Concerta, on the other hand, is a long-acting formulation of methylphenidate, also a CNS stimulant, and it primarily influences levels of dopamine and norepinephrine.
What is Vyvanse?
Lisdexamfetamine (the generic name for Vyvanse) was a major advancement in the class of drugs known as central nervous system (CNS) stimulants. It was first approved by the FDA in 2007. Vyvanse works by increasing levels of dopamine and norepinephrine in the brain, effectively prolonging their presence and enhancing their effects. It is prescribed for the treatment of attention deficit hyperactivity disorder (ADHD) and binge eating disorder. Vyvanse is a prodrug, which means it is inactive until metabolized by the body, resulting in a more gradual onset and longer duration of therapeutic action compared to other stimulants such as Concerta (methylphenidate). This feature of Vyvanse may result in less potential for misuse and a lower risk of side effects such as insomnia and appetite suppression.
What conditions is Vyvanse approved to treat?
Vyvanse has been approved for treating a range of conditions, which include:
- Attention Deficit Hyperactivity Disorder (ADHD) in both adults and children aged six years and above
- Moderate to severe Binge Eating disorder (BED) in adults
On the other hand, Concerta is primarily used for the treatment of:
- Attention Deficit Hyperactivity Disorder (ADHD) in adolescents aged 6 -18 years old
- Adults with ADHD who were diagnosed as children.
How does Vyvanse help with these illnesses?
Vyvanse works to manage attention deficit hyperactivity disorder (ADHD) by increasing the amount of dopamine and norepinephrine between synapses in the brain. It does this through promoting their release and blocking their reuptake into neurons, so levels can be maintained higher for longer periods of time. Dopamine and norepinephrine are neurotransmitters, chemicals that act as messengers in the brain and throughout the body, playing an important role in focus, motivation, mood regulation, memory formation among other functions. In individuals with ADHD, it is thought that there may be relatively lower levels or disrupted function of these neurotransmitters. Therefore, by increasing dopamine and norepinephrine availability Vyvanse can limit negative effects associated with ADHD such as distractibility or impulsivity helping patients manage their condition better.
What is Concerta?
Concerta is a brand name for methylphenidate, which is a central nervous system stimulant, meaning it affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. It achieves this by blocking the reuptake of norepinephrine and dopamine, thus increasing their levels in the brain. Concerta was first approved by the FDA in 2000. As methylphenidate is not a non-stimulant ADHD drug, it does not inhibit the reuptake of serotonin. Its mechanism of action means that its side-effect profile is distinct from that of non-stimulant ADHD drugs, notably in that it does not cause sedation and is less likely to cause weight gain (common side effects of non-stimulants). The effects on dopamine and norepinephrine can be beneficial for the treatment of ADHD, especially in patients who do not respond well to the “typical” non-stimulant ADHD drugs. Concerta's slow release mechanism provides a more steady and prolonged therapeutic effect compared to other stimulants like Vyvanse.
What conditions is Concerta approved to treat?
Concerta is a widely prescribed medication that has received approval from the FDA for the treatment of conditions such as:
- Attention-deficit/hyperactivity disorder (ADHD) in both children (6 years and older) and adults
- Narcolepsy, a neurological disorder that affects the control of sleep and wakefulness
How does Concerta help with these illnesses?
Dopamine is a neurotransmitter that plays an essential role in regulating focus, attention, and motivation. It is significantly involved in attention-deficit/hyperactivity disorder (ADHD). Concerta works by increasing the levels of dopamine available in the brain, thus helping to alleviate some of the symptoms of ADHD. Concerta's action involves a controlled release mechanism that provides therapeutic effects over a 12-hour span, which is beneficial for extended focus throughout the day. Although it shares similarities with Vyvanse, Concerta's unique extended-release formulation may offer specific advantages, such as a smoother onset and offset of action, which can minimize potential rebounds in ADHD symptoms. Just like Wellbutrin, Concerta may be prescribed when a patient does not respond well to other typical ADHD medications, or it may be combined with other drugs for a more tailored treatment approach.
How effective are both Vyvanse and Concerta?
Both lisdexamfetamine (Vyvanse) and methylphenidate (Concerta) have been approved by the FDA for treating attention deficit hyperactivity disorder (ADHD), with Concerta being approved in 2000, followed by Vyvanse in 2007. They both act on similar neurotransmitters but through different mechanisms and can be prescribed under varying circumstances.
A double-blind clinical trial was conducted in 2011 to compare the effectiveness of Vyvanse and Concerta, demonstrating that both drugs had comparable efficacy in managing symptoms of ADHD and shared a similar safety profile. However, there were no significant differences found between patients receiving Vyvanse or those taking Concerta when it came to improving attention span, impulsivity control, or behavior.
A review of meta-analysis reports on lisdexamfetamine shows its effectiveness can start from the first day of treatment. Its side effect profile is generally well-tolerated among patients across all age groups with minimal adverse effects compared to other psychostimulants used for ADHD treatment. The optimal dose varies significantly among individuals due to differing metabolism rates; however, it has proven effective at dosages as low as 30 mg/day.
Methylphenidate remains an often-prescribed choice for initial treatment due to its long-standing history and extensive research supporting its efficacy against placebos. While typically considered a first-line treatment option unlike bupropion discussed above, data confirming its superiority over newer alternatives such as lisdexamfetamine are not robust enough yet due to limited direct comparative studies between them. Despite this lack of evidence showing superior augmenting effects over other ADHD medications like amphetamines or atomoxetine so far, given methylphenidate's unique pharmacological characteristics include faster onset action than many alternatives which makes it oftentimes preferred especially where rapid symptom control is needed.
At what dose is Vyvanse typically prescribed?
Oral dosages of Vyvanse range from 30-70 mg/day, but studies have indicated that a starting dose of 30 mg/day is adequate for managing Attention Deficit Hyperactivity Disorder (ADHD) in most people. Children and adolescents may be started on this dosage. In either population, the dosage can be increased after one week if there is no sufficient response to initial therapy. The maximum daily dose should not exceed 70 mg/day. On the other hand, Concerta has a typical starting dose of 18-36 mg/day for children and adults new to treatment with it, which could also be adjusted upward depending upon the individual's response to medication and their doctor's recommendation--however, patients are generally advised not to exceed a maximum daily dosage of 72mg.
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At what dose is Concerta typically prescribed?
Concerta therapy is typically initiated at an 18 mg/day dose for patients new to methylphenidate or those switching from another medication. The dosage can be increased weekly by increments of 9–18 mg. A frequently used maximum dosage is 54 mg/day, however, this may vary depending on the patient's age and individual response to treatment. In some cases, a higher daily dose up to a maximum of 72 mg (for adults) could be tested if there isn't sufficient improvement in symptoms after several weeks at lower doses. Concerta should ideally be taken once daily in the morning; its effects will last about 12 hours with one single intake due to its unique extended-release formulation.
What are the most common side effects for Vyvanse?
Common side effects of Vyvanse and Concerta may include:
- Anxiety
- Nervousness
- Insomnia (trouble sleeping)
- Decreased appetite, which can lead to weight loss
- Dry mouth
- Increased heart rate or blood pressure
- Dizziness
- Sweating
- Restlessness
- Jitteriness, shakiness, or trembling hands
-Nausea or vomiting
-Stomach pain
-Diarrhea or constipation
-Irritability and mood swings
Keep in mind that this is not a complete list of potential side effects. It's also important to note that these medications affect everyone differently. If you notice any significant changes in your physical health or mental state after starting either medication, it's crucial to contact your healthcare provider immediately for guidance.
Are there any potential serious side effects for Vyvanse?
Both Vyvanse and Concerta are medications used to treat ADHD, but they can occasionally cause severe side effects:
- Unusual changes in mood or behavior, such as increased aggression, hostility or paranoia
- Allergic reactions which may be serious: swelling of the face, lips or throat that might cause difficulty breathing; hives; skin rashes with blistering and peeling
- Vision problems: blurred vision, eye pain or redness
- Heart-related issues: fast pounding heartbeats, chest discomfort/pressure/tightness/pain; shortness of breath
- Low levels of sodium in the body - headache, confusion, slurred speech, severe weakness/vomiting/loss of coordination/unsteady feeling.
- Nervous system reaction – rigid muscles/high fever/sweating/confusion/fast or uneven heartbeats/tremors/fainting.
If you experience any of these symptoms while taking either Vyvanse or Concerta you should seek medical attention immediately. It's worth noting that both drugs also have a small risk of causing serotonin syndrome (symptoms include agitation/hallucinations/fever/sweating/shivering/fast heart rate/muscle stiffness/twitching /nausea/vomiting/diarrhea). This is more likely when taken with certain other medications so always inform your doctor about all medication you're taking.
What are the most common side effects for Concerta?
When taking Concerta, individuals may experience:
- Dry mouth or throat
- Increased sweating
- Nervousness or anxiety
- Rapid heartbeat
- Sleep disturbances like insomnia
- Headache, dizziness, and sometimes blurred vision
- Possible digestive issues such as nausea, vomiting, stomach pain and constipation
- A potential for weight loss due to suppressed appetite
- Some may encounter muscle or joint pain.
It's crucial to note that while these side effects are possible with Concerta use, not all patients experience them. If you're considering this medication or any other medication changes always consult your healthcare provider first.
Are there any potential serious side effects for Concerta?
While Concerta is generally well-tolerated, there are instances where it could cause serious side effects. Some of these signs might include:
- Allergic reactions such as skin rash or hives, itching, difficulty breathing, swelling in your face or throat
- Increased heart rate or blood pressure
- Enhanced feelings of depression or anxiety accompanied by suicidal thoughts
- Seizures (convulsions)
- Mood changes: paranoia, hostility and disorientation
- Vision problems like blurred vision and difficulty focusing on objects close-up
- Signs suggestive of a cardiovascular event like chest pain, shortness of breath and fainting.
If you experience any of the above symptoms after using Concerta, stop taking the medication immediately and seek urgent medical help to avoid further complications.
Contraindications for Vyvanse and Concerta?
Both Vyvanse and Concerta, along with most other stimulant medications, may worsen symptoms of anxiety or agitation in some people. If you notice your anxiety worsening, or an increase in aggressive behavior or thoughts, please seek immediate medical attention.
Neither Vyvanse nor Concerta can be taken if you are taking or have been taking monoamine oxidase (MAO) inhibitors within the past 14 days. Always inform your healthcare provider about all the medications you are currently on; MAOIs will require a period of about 2 weeks to clear from the system to prevent dangerous interactions with both Vyvanse and Concerta.
How much do Vyvanse and Concerta cost?
For the brand name versions of these drugs:
- The price of 30 capsules of Vyvanse (30 mg) averages around $380, which works out to approximately $12.67/day.
- The price of 30 tablets of Concerta (18 mg) averages about $285, working out to roughly $9.50/day.
Thus, if you are taking a typical dosage for ADHD treatment with either drug (i.e., between 20 and 60mg per day), then brand-name Concerta is less expensive on a per-day treatment basis. However, it's important to remember that cost should not be the primary consideration in determining which medication is right for you.
There are currently no generic forms available for Vyvanse or Concerta specifically due to patent restrictions. Nonetheless, other generic forms of extended-release methylphenidate (the active ingredient in Concerta) may offer cost savings compared to branded options. Always consult your healthcare provider or pharmacist when considering different medications and dosages as they can provide guidance based on your specific needs and circumstances.
Popularity of Vyvanse and Concerta
Lisdexamfetamine, known by the brand name Vyvanse, was estimated to have been prescribed to about 10.7 million people in the US in 2020. This accounted for just over 28% of ADHD prescriptions in the country. Lisdexamfetamine is a prodrug, which means it's inactive until metabolized within the body – this can help deter misuse and provides a more gradual onset and offset of therapeutic action.
On the other hand, Methylphenidate ER under its brand name Concerta was prescribed to approximately 6 million individuals across America during the same year. It accounts for roughly around 16% of all ADHD medication prescriptions dispensed from pharmacies across the US. The prevalence of Methylphenidate ER has been relatively steady over recent years with only minor fluctuations observed since it first came into use several decades ago.
Conclusion
Both Vyvanse (lisdexamfetamine) and Concerta (methylphenidate) are frequently used in managing attention-deficit/hyperactivity disorder (ADHD), and their efficacy is supported by a multitude of clinical studies proving that they are more effective than placebo treatments. These medications can sometimes be prescribed together but this requires careful consideration by a healthcare provider due to potential interactions. Their mechanisms of action differ, with Vyvanse working primarily on norepinephrine and dopamine, while Concerta acts mainly on dopamine.
Vyvanse's unique prodrug formulation makes it less prone to abuse compared to other ADHD medications, leading some practitioners to prefer it as a first-line treatment option. On the other hand, Concerta might be considered as an alternative for patients who did not respond well to initial lisdexamfetamine therapy or have specific needs such as avoiding common side effects like appetite suppression or insomnia.
Both drugs come in generic forms which could mean significant cost savings for those paying out-of-pocket. Both Vyvanse and Concerta may require an adjustment period since the full therapeutic effect may take several weeks to become apparent.
While both drugs have comparable safety profiles and are generally well-tolerated, each has its own set of side effects. For instance, Vyvanse is less likely than Concerta to cause sleep disturbances but more likely to suppress appetite. As always when starting these types of therapies, patients need close monitoring – especially if they notice worsening symptoms or begin having thoughts about self-harm - immediate medical help should be sought.