Taking Concerta And Vyvanse Together

In our latest question and answer, the pharmacist discusses combining Concerta and Vyvanse for treating ADHD.

Question

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

Asked by FishyOne On Nov 08, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Nov 08, 2022
Last updated Apr 19, 2024

Key points

  • Concerta and Vyvanse are both long-acting stimulants but contain different drugs (methylphenidate vs. lisdexamfetamine).
  • When stimulants are combined, generally a long-acting stimulant is used with a short-acting stimulant. It is uncommon to combine to combine long-acting stimulants.
  • Some individuals may respond better to certain stimulant medications. It is important to talk to your doctor about your 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.

While both Vyvanse and Concerta are CNS (central nervous system stimulants), they are two distinct drugs.

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 end 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

  • 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

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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