The basic difference between Adderall and Vyvanse is that Adderall is a mixture of four different kinds of amphetamine salts (one of which is dextroamphetamine) while Vyvanse only contains one salt, called lisdexamfetamine, which only gets converted into dexamphetamine once it is in the body.
Because both drugs contain amphetamines, they work in a similar way. Studies have shown that Vyvanse is just as effective as Adderall, and side effects are similar. One advantage of Vyvanse is that it may be less likely to be abused; however, there is no generic form available so it is more costly than generic forms of Adderall. Risk of dependence (coming to rely on the drug) appears similar for both.
What is in Adderall and Vyvanse?
Adderall is a brand name for a combination drug that contains four different types of amphetamines (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate). It's easier to call these mixed amphetamine salts, or MAS for short.1
Vyvanse is the brand name for lisdexamfetamine. Once lisdexamfetamine is inside the body it gets converted into dextroamphetamine (its active form) as soon as it touches red blood cells.2
Because Adderall and Vyvanse both contain amphetamines they work in a similar way, and that is by blocking the re-uptake of two neurotransmitters (chemical substances that help nerves talk to each other) in the body. These neurotransmitters are called norepinephrine and dopamine. By blocking their re-uptake, levels of these neurotransmitters between nerves are increased, which helps relieve symptoms of inattention and agitation in children and adults with ADHD.1
Are there any studies that directly compare Adderall to Vyvanse?
Unfortunately, researchers have not really looked into how effective Adderall is compared to Vyvanse, and vice-versa. One study did look at the effect both drugs had on classroom-based behavior in a group of children with ADHD, and reported that both seemed equally effective at improving attention-span, rule following and interactions with peers and adults. Both were well tolerated and no significant differences were noted in their side effects.3,4
Similar results were reported in a trial of 18 adults with ADHD. It took about two hours for Adderall to start working and three hours for Vyvanse, and the effects of each drug lasted for approximately 16 hours. 5,6
Many other studies have compared Adderall or Vyvanse to placebo (an inactive pill) or to other medications used for ADHD and confirmed that both Adderall and Vyvanse improve various symptoms of ADHD.7,8,9,10,11 Researchers did not find one type of drug more effective than another and side effects such as decreased appetite, insomnia, and abdominal symptoms were common but similar among different preparations. However, it is worthwhile noting that most trials in people with ADHD last less than six months, are poorly reported and fail to include important social outcomes such as parent stress and quality of life.
Which drug is more likely to be abused?
Adderall has more potential to be abused, mainly because it contains free amphetamine salts. Because lisdexamfetamine (the ingredient of Vyvanse) requires contact with red blood cells in the body to be activated into dextroamphetamine, it has inbuilt abuse-deterrent properties4... In theory anyway. Unfortunately, no head-to-head trials comparing the abuse potential of Vyvanse to Adderall have been done.4,12
Lisdexamfetamine is still classified as a controlled substance with a high potential for abuse, and those people prescribed Vyvanse and Adderall should take care to store their medicines safely to avoid non-authorized use, as misuse of amphetamine-type medicines can cause sudden death, stroke, heart attack, convulsions and psychotic reactions.1,2,12
Which is cheaper? Adderall or Vyvanse?
Because Adderall is available in a generic form, it can be purchased for less than Vyvanse. Adderall XR costs approximately $760 per 100 capsules ($7.60 per capsule)13, and the generic version is available for $465-$533 for 100 capsules (from $4.65 per capsule)14.
Lisdexamfetamine is only available as Vyvanse, at a cost of $884 for 100 capsules ($8.84 per capsule).15 Don't hold your breath for a generic - one isn't expected until 2023!16
Is Adderall better because it is available as an extended-release?
No. Although Adderall is available in both an immediate-release and extended-release form, an expert review failed to find any differences in effectiveness between immediate and extended-release dosage forms.10Interestingly, Vyvanse actually "behaves" like an extended-release form once it is inside the body - because the contact with red blood cells and the cleaving off of dextroamphetamine takes time. 4
- Adderall (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate) [package insert]. Revised 12/2015 Teva Select Brands https://www.drugs.com/pro/adderall.html
- Vyvanse (lesdexamfetamine) [package insert]. Revised 12/2015 Shire LLC https://www.drugs.com/pro/vyvanse.html
- Biederman J, Boellner S, Childress A, et al. Improvements in Symptoms of Attention- Deficit/HyperactivityDisorder in School-aged Children With Lisdexamfetamine (NRP104) and Mixed Amphetamine Salts, Extended-Release Versus Placebo. Presented at the 159th Annual Meeting of the American Psychiatric Association, Toronto, Ontario, Canada, May 24, 2006. http://library.corporate-ir.net/library/17/179/179878/items/204049/5- 2406%20Poster%20APA%20Presentation.pdf
- Allen SN. Adderall XR® and Vyvanse™. New" psychotropics: New chemical entities and new dosage forms. Mental Health Clinician 2014;4(1):8-10. http://mhc.cpnp.org/doi/full/10.9740/mhc.n186948
- Martin PT, Corcoran M, Zhang P, Katic A. Randomized, Double-Blind, Placebo-Controlled, Crossover Study of the Effects of Lisdexamfetamine Dimesylate and Mixed Amphetamine Salts on Cognition Throughout the Day in Adults with Attention-Deficit/Hyperactivity Disorder. Clinical Drug Investigation. 2014;34(2):147-57. doi:10.1007/s40261-013- 0156-z.
- Faraone S V, Biederman J. Efficacy of Adderall for attention‐deficit/hyperactivity disorder: a meta‐analysis. Journal of Attention Disorders.2002;6(2):69‐75
- Maneeton N, Maneeton B, Suttajit S et al. Exploratory meta-analysis on lisdexamfetamine versus placebo in adult ADHD. Drug Des Devel Ther. 2014; 8: 1685–93 doi: 10.2147/DDDT.S68393 PMCID: PMC4199984 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199984/
- Isquith PK, Roth RM, Gioia GA, and PAR Staff. Behavior Rating Inventory of Executive Function -Adult Version™ BRIEF-A™. Interpretive Report. Uploaded 09/2006 http://www4.parinc.com/WebUploads/samplerpts/BRIEFA_InformantInterp.pdf Accessed 03/2016
- Wigal SB, Raja P, Shukla A. An update on lisdexamfetamine dimesylate for the treatment of attention deficit hyperactivity disorder. Expert Opin Pharmacother. 2013 Jan;14(1):137-45. doi: 10.1517/14656566.2013.754013. http://www.tandfonline.com/doi/abs/10.1517/14656566.2013.754013?journalCode=ieop20
- Castells X, Ramos-Quiroga JA, Bosch R, et al. Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD007813. DOI: 10.1002/14651858.CD007813.pub2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007813.pub2/full
- Punja S, Shamseer L, Hartling L, et al. Amphetamines for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD009996. DOI: 10.1002/14651858.CD009996.pub2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009996.pub2/full
- Simon K, Worthy SL, Barnes MC, Tarbell B. Abuse-deterrent formulations: transitioning the pharmaceutical market to improve public health and safety. Therapeutic Advances in Drug Safety. 2015;6(2):67-79. doi:10.1177/2042098615569726. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406920/
- Adderall XR Prices, Coupons and Patient Assistance Programs Drugs.com https://www.drugs.com/price-guide/adderall-xr Accessed 03/2016
- Amphetamine/dextroamphetamine Prices, Coupons and Patient Assistance Programs. Drugs.com https://www.drugs.com/price-guide/amphetamine-dextroamphetamine Accessed 03/2016
- Vyvanse Prices, Coupons and Patient Assistance Programs. Drugs.com https://www.drugs.com/price-guide/vyvanse
- Anticipated Availability of First-Time Generics. Pharmacist’s letter/Prescriber’s letter February 2016
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