Focalin and Adderall are both used for ADHD, but is one more effective than the other?
Focalin contains dexmethylphenidate whereas Adderall contains a mixture of amphetamine salts (MAS).
What is Dexmethylphenidate?
Dexmethylphenidate (Focalin) is a man-made stimulant that is derived from methylphenidate (which is marketed under brand names such as Ritalin, Concerta, Metadate, and others). Dexmethylphenidate is the more active part of methylphenidate, which is why Focalin is considered twice as strong, on a mg for mg basis, as drugs such as Ritalin and Concerta. Focalin was first approved in 2001, although an extended-release form was not approved until 2005.
What is in Adderall?
The mixed amphetamine salts contained in Adderall are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate; often abbreviated to 75% dextroamphetamine + 25% levoamphetamine. Adderall is also a man-made stimulant and was first approved in 1996. Both Focalin and Adderall are approved to treat ADHD, although Adderall is also approved to treat narcolepsy.
How do Focalin and Adderall work in ADHD?
Although Focalin is not an amphetamine and has a different mechanism of action to Adderall, it bears some structural resemblance to amphetamines and both drugs are thought to work in ADHD by increasing the concentration of two neurotransmitters (dopamine and norepinephrine) in the brain.
Immediate-release (IR) forms of Focalin have a duration of effect of 4 to 6 hours, similar to that of Adderall IR. Extended-release (XR) forms of Focalin provide a sustained psychostimulant effect for up to 12 hours, similar to that of Adderall XR. Focalin IR has only three dosage options (2.5 mg, 5 mg, and 10 mg) compared to seven for Adderall IR (5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg), which may make Adderall IR easier for titrating. Focalin XR has more dosage options than Adderall XR. Immediate-release forms of Focalin are generally cheaper than immediate-release forms of Adderall; however, brand-name Adderall XR is usually cheaper than Focalin XR. Both Focalin and Adderall are available as generics.
Although neither Focalin XR capsules nor Adderall XR capsules should be chewed or crushed, for people who have difficulty swallowing the capsules may be opened and the contents sprinkled on apple sauce and swallowed straight away. Both Focalin and Adderall may cause dizziness, insomnia, nervousness, stomach aches and a decrease in appetite leading to weight loss. Adderall may also cause diarrhea, dry mouth, fever, headache, irritability, nausea and vomiting. Subjective, anecdotal reports have suggested that Focalin may have a cleaner effect than Adderall and produce less jitters. Side effects of both drugs are more likely at higher dosages.
Potential For Abuse
Both Focalin and Adderall are habit-forming and have a high potential for abuse and are classified as “Schedule II” controlled-substances. It is not uncommon for people who have taken either Focalin or Adderall for extended periods of time to become psychologically dependent on them. Tolerance may also develop - this when an increasing dose is needed in order to achieve the same reduction in symptoms. Both can lead to withdrawal symptoms on discontinuation. Studies have not directly compared the two drugs for abuse or dependence potential; however, it is likely to be similar and high. Adderall tends to be more popular than Focalin among college students who misuse the drug for studying, passing tests, and even weight loss (see Adderall for Study: Does it Really Make You Smarter?
Studies have shown that Focalin and Adderall are both more effective in ADHD than a placebo (pretend) tablet but there have been few trials directly comparing the two drugs. Those that do suggest that Focalin and Adderall are nearly identical in terms of potency (meaning 5mg Focalin IR is approximately equivalent to 5mg Adderall IR and 10mg of Focalin XR approximately equals 10mg Adderall XR). However, not everybody responds equally to either Focalin or Adderall. In one study involving 56 children, 14.3% only responded to dexmethylphenidate XR (Focalin XR) and 12.5% only responded to mixed amphetamine salts XR (Adderall XR). This means that if one treatment is ineffective or intolerable it is appropriate to try another before giving up on stimulant treatment. Behavioral therapy is still recommended as the first treatment to try before medication in young children with ADHD.
Focalin and Adderall appear equally effective for ADHD and have a similar potency on a mg per mg basis. Side effects are similar. Adderall IR has more dosage options than Focalin IR, although Focalin IR is usually cheaper. Focalin XR has more dosage options than Adderall XR, although Adderall XR is usually cheaper. Both have a high potential for abuse and dependence, although the risk may be perceived as higher with Adderall because it is more popular; however, this does not mean Focalin is less likely to cause tolerance or dependence. Studies have shown that individual responses to ADHD medications varies, and up to 15% of people have a response to one drug but not to another. Therefore it is worthwhile trying a different type of ADHD medication if one treatment is found to be ineffective.
- 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
- Focalin (dexmethylphenidate) [Package Insert] Novartis Pharmaceuticals Corporation. Revised 06/2015. https://www.drugs.com/pro/focalin-xr.html
- Weiss M, Wasdell M, Patin J et al. A post hoc analysis of d-threo-methylphenidate hydrochloride (focalin) versus d,l-threo-methylphenidate hydrochloride (ritalin). J Am Acad Child Adolesc Psychiatry. 2004 Nov;43(11):1415-21.
- Stein MA, Waldman ID, Charney E, et al. Dose Effects and Comparative Effectiveness of Extended Release Dexmethylphenidate and Mixed Amphetamine Salts. Journal of Child and Adolescent Psychopharmacology. 2011;21(6):581-588. doi:10.1089/cap.2011.0018.
- Moen MD, Keam SJ. Dexmethylphenidate extended release: a review of its use in the treatment of attention-deficit hyperactivity disorder. CNS Drugs. 2009 Dec;23(12):1057-83. doi: 10.2165/11201140-000000000-00000.
- Focalin vs. Adderall: Comparison. Mental Health Daily. 2015. http://mentalhealthdaily.com/2015/06/02/focalin-vs-adderall-comparison/
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