Taking Concerta And Vyvanse Together
In our latest question and answer, the pharmacist discusses combining Concerta and Vyvanse for treating ADHD.
Can you think of any downsides to combining Vyvanse and Concerta if the person (diagnosed with ADHD and under a psychiatrist’s care) responds well to both stimulants independently? The issue is that the Vyvanse seems better at improving movement and irritability but the Concerta seems better at the so-called 'Executive Functions' of the prefrontal cortex. Obviously, the doses would not be the same as if only one of the medications are taken. But overall, are there advantages and disadvantages to this for some people with ADHD? Thank you
Nov 08, 2022- There are no established guidelines recommending Vyvanse and Concerta together, though some doctors do prescribe this combination based on individual patient response and the fact that these are two different types of stimulants that may work better for different ADHD symptoms.
- Combining two long-acting stimulants is uncommon and you may face insurance coverage challenges, but there is nothing inherently unsafe about it if your doctor determines appropriate doses for your situation.
- You should discuss with your doctor whether this combination makes sense for you, as ADHD treatment is highly individualized and other medication combinations may also be options.
Answer
There are currently no studies or guidelines that recommend the combined use of Vyvanse and Concerta together, which are both long-acting stimulants. However, in practice, there are some providers that do prescribe and dose two different stimulant medications to their patients for daily use based on response and efficacy.
Typically when this occurs (combining stimulants), it is an extended-release medication (like Concerta) prescribed for daily coverage, and an immediate-release product (e.g. Adderall) prescribed during the day to be used as needed (i.e. as a "booster").
However, while uncommon, there can be a case made where two long-acting stimulants could be beneficial.
Vyvanse contains lisdexamfetamine, a type of amphetamine, while Concerta contains methylphenidate. It is not uncommon that an individual responds better to one type of stimulant than another, or that one is better at treating certain aspects of ADHD.
What Do The Studies Say?
It would be relatively uncommon for two long-acting ADHD stimulants, like Vyvanse and Concerta, to be prescribed together but there certainly could be individual cases where the combination is safe to and effective for use.
It's highly individualized and you should speak to your doctor regarding your options. Most often though, a stimulant is combined with a non-stimulant medication to attain complete coverage of symptoms.
While not completely akin to using two long-acting stimulants, current research shows that the combination of two ADHD medications (in different medication classes) can be far more effective than a single agent.
For example, guanfacine combined with Focalin (dexmethylphenidate) showed more consistent benefits for ADHD symptoms than either agent alone.
Another study showed that the combination of Strattera (atomoxetine) and different amphetamine stimulants were more effective than a single agent for certain individuals.
As you mentioned in your question, there is some data to suggest that certain types of stimulants can provide better symptom control for certain aspects of ADHD, for some people (e.g. methylphenidate being more effective for 'executive function').
Combining Vyvanse And Concerta
While uncommon, there could be certain individuals that benefit from combining both an amphetamine (e.g., Vyvanse) and methylphenidate (e.g., Concerta).
In most cases though, if this combination were to be prescribed for you, it would likely be with two immediate-release drugs (e.g. dextroamphetamine and methylphenidate IR) OR a short-acting with a long-acting one.
Not only is it uncommon to be prescribed two long-acting stimulants, but you'll also likely have some trouble with your insurance company getting both covered.
Nevertheless, if you have found in the past that these stimulants have each provided positive benefits for different symptoms, the combination could make sense for you. There isn't anything inherently unsafe about combining two different types of stimulants, assuming the appropriate doses are used. Be sure to talk to your doctor about what your options are.
Final Words
The choice of medication(s) for the treatment of ADHD and other co-morbid conditions (i.e. the presence of other diseases such as ADHD with anxiety) is highly individualized.
While the use of two long-acting stimulant medications isn't unheard of, it is not common. Generally, the combination of a stimulant and non-stimulant medication is more often used to appropriately treat all symptoms and conditions.
References & sources
- A Systematic Review of Combination Therapy with Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder, Including Patient Characteristics, Treatment Strategies, Effectiveness, and Tolerability — PubMed
- The Pharmacology of Amphetamine and Methylphenidate: Relevance to the Neurobiology of Attention-Deficit/Hyperactivity Disorder and Other Psychiatric Comorbidities — PubMed
- Effect of methylphenidate on executive functioning in adults with attention-deficit/hyperactivity disorder: normalization of behavior but not related brain activity — PubMed
Glossary — Terms in This Answer
- Extended-release
- A medication formulation designed to release the drug slowly over many hours, providing steady medication levels throughout the day.
- Immediate-release
- A medication formulation that releases the drug quickly into the bloodstream, providing fast but shorter-lasting effects.
- CNS stimulants
- Medications that increase activity in the central nervous system (brain and spinal cord) to improve focus and alertness.
- Lisdexamfetamine
- The active ingredient in Vyvanse, a type of amphetamine used to treat ADHD.
- Methylphenidate
- The active ingredient in Concerta and Ritalin, a stimulant medication used to treat ADHD.
- ADHD
- Attention-Deficit/Hyperactivity Disorder, a condition affecting focus, impulse control, and activity levels.
- Co-morbid conditions
- When two or more diseases or disorders exist together in the same person at the same time.
- Booster
- An additional dose of medication taken during the day to increase or restore the medication's effect when needed.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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