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Concerta Vs Adderall: What's the difference between them?

Answers (1)

Official Answer by Drugs.com 12 Apr 2016

Short answer

Concerta contains methylphenidate whereas Adderall contains a mixture of amphetamine salts (MAS). Although Concerta and Adderall contain different ingredients, they are both classified as CNS stimulants and are thought to work in a similar way in ADHD - by increasing the concentration of two neurotransmitters (dopamine and norepinephrine) in the brain.

Direct comparison studies and placebo trials indicate that both drugs are effective in ADHD, although it is worthwhile noting that most trials are of poor quality and short duration. Concerta and Adderall are both associated with sleep problems and a decreased appetite; in addition, Concerta is more likely to cause stomach pain.

Not everybody responds equally to either Concerta or Adderall so if one treatment is ineffective or intolerable it is appropriate to try another. Abuse or dependence potential is untested, but likely to be similar.

Long answer

Are Concerta and Adderall the same?

Not as far as ingredients go. Concerta is a brand name for methylphenidate and Adderall contains mixed amphetamine salts.1,2 Although they both contain different ingredients, they are both classified as CNS stimulants and are thought to work in a similar way – by increasing the concentrations of norepinephrine and dopamine in the brain. These two neurotransmitters transmit impulses between nerves, which helps improve ADHD symptoms such as hyperactivity, impulsiveness and inattention. Methylphenidate is available as a generic and other brands include Aptensio, Metadate, Methylin, Quillivant and Ritalin.1

The mixed amphetamine salts contained in Adderall are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate.  Adderall is also available as a generic.2

Do any studies directly compare Concerta to Adderall?

Yes. Several trials have directly compared methylphenidate (contained in Concerta) to amphetamines (such as Adderall) in a cross-over type design (one drug is given for a few weeks followed by the other drug after a period of no drug). Most were done pre-1996 and numbers of patients included in each study were too low to report any statistically significant difference between the two drugs. One trend did emerge though, and that was that every study had some subjects who responded better to one drug and not the other. For most it tended to be a two-way street with some people responding better to methylphenidate, and others responding better to amphetamine-type drugs.3

Behavioral therapy is still recommended as first-line treatment for ADHD in young children. If, after weighing up risks versus benefits, medications are deemed appropriate to use in children with ADHD, continuous monitoring for improvement or development of side effects should be undertaken. If one ADHD medication fails, it is appropriate to try another before giving up on stimulant treatment.3

So are stimulants actually effective for ADHD?

Stimulants are effective for ADHD; however, it is worthwhile noting that the majority of trials have been of poor quality and relatively short duration. It is difficult for trials involving CNS stimulants not to be bias in some way – disguising the effects of a stimulant drug is practically impossible, particularly in trials comparing it to placebo, and most trial participants, clinicians and researchers are able to work out who is taking active drug and who is taking placebo.

A Cochrane group recently reviewed the results of 185 trials involving methylphenidate for the treatment of ADHD.4 The authors concluded that although methylphenidate appeared to modestly improve symptoms such hyperactivity, impulsivity, and difficulty in concentrating they couldn’t say for sure how much of a difference it made because many trials failed to completely report all results, and outcomes were not consistent across all trials. The only definite conclusions to come out of the review were that methylphenidate is associated with sleep problems and a decreased appetite, but trials were of too short a duration (less than 6 months) to confirm any risk of serious adverse effects associated with long-term use.

In another review, the Cochrane group investigated the effectiveness of amphetamines in ADHD, and 23 relevant trials were identified.5 Once again, although amphetamines were effective at improving core ADHD symptoms in the short term, the quality of included studies was classed as low to very low. Children taking amphetamine salts were also more likely to experience sleep problems, decreased appetite, and stomach pain. Although this review included a number of different types of amphetamines (lisdexamfetamine, dextroamphetamine, and mixed amphetamine salts) there was no evidence that one kind of amphetamine was any better than another. Trials were of too short a duration to predict safety with long term use and no benefits were found for amphetamines that act for longer periods of time versus those that act for shorter.

Which one is more likely to be abused?

Both Concerta and Adderall have the potential to be abused.1,2,6 There is a misconception among teenagers and young adults that prescription stimulants can improve a person’s ability to learn and so are taken to boost study performance. Although prescription stimulants promote wakefulness, research has shown that students who abuse them actually have lower high school and college GPAs than those who don’t. Thinking or learning ability does not appear enhanced in those without ADHD.7 Unfortunately, no head-to-head comparison trials comparing the abuse potential of Concerta and Adderall have been done.

What about costs?

Adderall is available in both brand and generic. Adderall XR costs approximately $7.60 per capsule)8, and a generic version is available for $4.65-5.33 per capsule.9

Extended-release Concerta tablets cost approximately $8.60 per 36mg tablet and $9.25 per 54mg tablet.10 Generic methylphenidate is also available at a cost of $3.90 per 40mg extended-release tablet and $7.10 per 50mg extended-release tablet.11

References

  1. Concerta (methylphenidate hydrochloride) [package insert] Janssen Pharmaceuticals, Inc Revised 09/2015 https://www.drugs.com/pro/concerta.html
  2. 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
  3. Arnold LE. Methylphenidate vs. amphetamine: Comparative review. Journal of Attention Disorders. 2000;3(4):200-11 doi: 10.1177/108705470000300403
  4. Storebø O, Ramstad E, Krogh H, Nilausen T, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira-Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD009885. DOI: 10.1002/14651858.CD009885.pub2
  5. 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
  6. 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/
  7. DrugFacts: Stimulant ADHD Medications: Methylphenidate and Amphetamines National institute on drug Abuse. Jan 2014. https://www.drugabuse.gov/publications/drugfacts/stimulant-adhd-medications-methylphenidate-amphetamines
  8. Adderall XR Prices, Coupons and Patient Assistance Programs Drugs.com https://www.drugs.com/price-guide/adderall-xr Accessed 03/2016
  9. Amphetamine/dextroamphetamine Prices, Coupons and Patient Assistance Programs. Drugs.com https://www.drugs.com/price-guide/amphetamine-dextroamphetamine Accessed 03/2016
  10. Concerta Prices, Coupons and Patient Assistance Programs. Drugs.com Accessed 04/2016 https://www.drugs.com/price-guide/concerta
  11. Methylphenidate Prices, Coupons and Patient Assistance Programs. Drugs.com Accessed 04/2016 https://www.drugs.com/price-guide/methylphenidate#oral-tablet-extended-release-18-mg-24-hr
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