Ritalin is a brand name for methylphenidate, and Vyvanse is the brand name for lisdexamfetamine. Both drugs are CNS stimulants and both are believed to have a similar mechanism of action; however, some trials indicate Vyvanse may be more effective at relieving ADHD symptoms. Vyvanse appears to cause more side effects, such as decreased appetite, weight loss, insomnia, and nausea than Ritalin. Both slow growth rate in children and adolescents, possibly Vyvanse to a larger extent. Ritalin is more likely to be discontinued because of ineffectiveness and Vyvanse is more likely to be discontinued because of side effects.
Because Vyvanse is a pro-drug it has less potential than Ritalin to be abused, although head-to-head comparisons investigating abuse and dependence potential have not been done. Ritalin is much cheaper than Vyvanse and the drug, methylphenidate, is available generically. A generic form of Vyvanse is not expected to be available until 2023.
How do the ingredients in Ritalin and Vyvanse differ?
Ritalin is a brand (trade) name for methylphenidate. Experts are not sure exactly how methylphenidate works in Attention Deficit Hyperactivity Disorder (ADHD) but believe it blocks the re-uptake of norepinephrine and dopamine, two neurotransmitters located in the brain. This causes an increase in levels of these chemicals between the nerves, and helps to calm hyperactivity and improve deficits in concentration. 1 Ritalin 5mg costs approximately $75 for 100 tablets (75 cents per tablet) increasing to $108.87 for 60 tablets for the 20mg dose ($1.80 per tablet).2
Other brands of methylphenidate include Aptensio XR, Concerta, Daytrana, Metadate, Quillichew and Qullivant.3
Vyvanse is the brand name of lisdexamfetamine (LDX). LDX is a prodrug of dextroamphetamine, which means it needs to be absorbed by the body and come into contact with red blood cells before it is converted into dextroamphetamine, its active form.4 Dextroamphetamine is also thought to work by increasing levels of norepinephrine and dopamine in the nerve synapse. LDX is only available as the brand Vyvanse, at a cost of $884 for 100 capsules ($8.84 per capsule).5 The anticipated availability of a generic for LDX is 2023.6
Have any studies been done comparing Ritalin to Vyvanse
Unfortunately, no. Very few studies have been done comparing Ritalin to Vyvanse in either children or adults with ADHD.
More children reported a greater improvement in ADHD symptoms after treatment with LDX than those treated with an extended-release form of methylphenidate.7 53% of children assigned to methylphenidate were taking the highest available dose (54 mg/day) compared to only 33% of children on LDX (the highest available dose of LDX was 70 mg/day). More children discontinued methylphenidate because of ineffectiveness. However, more children on LDX reported intolerable side effects forcing discontinuation. Incidence of poor appetite, weight loss, insomnia, and nausea was higher in children treated with LDX compared to methylphenidate. Methylphenidate was more likely than LDX to cause headache and nasopharyngitis (inflammation of the mucous membranes of the nose and upper airways).
In another study that looked at children who had discontinued methylphenidate due to ineffectiveness, response to LDX was significantly greater than that to Atomoxetine, another drug also used for ADHD.8
What are the effects of Ritalin and Vyvanse on growth rate
Children consistently administered methylphenidate experience a temporary slowing of growth (on average about 2cm less growth in height and 2.7kg less growth in weight over 3 years).9
For Vyvanse, weight loss depended on dose and was reported as 0.9 pounds (30mg dose), 1.9 pounds (50mg dose) and 2.5 pounds (70mg dose) after 4 weeks of therapy. Children randomized to placebo on average gained 1 pound. In older children, weight loss ranged from 2.7 to 4.8 pounds over 4 weeks.4
Generally, children taking LDX gain less height and weight and have a lower BMI than those not taking LDX, regardless of height and weight when they are first administered the drug. In fact, heavier and taller children on study entry are more likely to experience more significant growth delays than shorter and lighter children. A child's growth should be closely monitored for changes from the norm and corrective action taken should significant changes be apparent.10
Which drug is more likely to be abused?
Unfortunately, both Ritalin and Vyvanse, as with other “hyperactivity” drugs are commonly misused, particularly by high school and college students. Misuse of Ritalin, Vyvanse, and other CNS stimulants has been associated with sudden death, stroke, heart attack, convulsions and psychotic reactions indistinguishable from schizophrenia.11,12,13
However, Vyvanse theorectically has less abuse potential, because of its pro-drug formulation and need to be in contact with red blood cells before it changes into its active form, dextroamphetamine.13,14 Unfortunately, no head-to-head comparison trials comparing the abuse potential of Vyvanse and Ritalin have been done.
- Methylphenidate. Drugs.com https://www.drugs.com/methylphenidate.html
- Ritalin prices, coupons, and patient assistance programmes. https://www.drugs.com/price-guide/ritalin
- Methylphenidate. Drugs at FDA. https://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm
- Vyvanse (lesdexamfetamine) [package insert]. Revised 12/2015 Shire LLC https://www.drugs.com/pro/vyvanse.html
- 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
- Soutullo C1, Banaschewski T, Lecendreux M, et al. A post hoc comparison of the effects of lisdexamfetamine dimesylate and osmotic-release oral system methylphenidate on symptoms of attention-deficit hyperactivity disorder in children and adolescents. CNS Drugs. 2013 Sep;27(9):743-51. doi: 10.1007/s40263-013-0086-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751426/
- Dittmann RW, Cardo E, Nagy P, et al. Treatment Response and Remission in a Double-Blind, Randomized, Head-to-Head Study of Lisdexamfetamine Dimesylate and Atomoxetine in Children and Adolescents with Attention-Deficit Hyperactivity Disorder. CNS Drugs. 2014;28(11):1059-1069. doi:10.1007/s40263-014-0188-9.
- Methylphenidate [package insert] Revised 5/2015 Kremers Urban Pharmaceuticals Inc https://www.drugs.com/pro/methylphenidate-cd-capsules.html
- Faraone SV, Spencer TJ, Kollins SH, and Glatt SJ. Effects of lisdexamfetamine dimesylate treatment for ADHD on growth. J Am Acad Child Adolesc Psychiatry. 2010 Jan;49(1):24-32.
- Ritalin (methylphenidate) [package insert] Revised 4/2015 Novartis Pharmaceuticals Corporation https://www.drugs.com/ritalin.html
- 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
- 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/
- Barry F. FDA says no to anti-addiction rule on Ritalin, painkillers. 09/2014 http://www.in-pharmatechnologist.com/Regulatory-Safety/FDA-says-no-to-anti-addiction-rule-on-Ritalin-painkillers
- Ritalin Drug Information
- Vyvanse Drug Information
- Lisdexamfetamine Drug Information
- Methylphenidate Drug Information
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