In the 1920s amphetamines were noticed and studies for medical usage began. The first uses in medicine were to wake people from anesthesia and for treating narcolepsy. In 1937 Bradley first discovered the benefit of amphetamine drugs for children with Attention-deficit/hyperactivity disorder (ADHD).
In his first studies, he found that over half the patients tested were able to improve their behavior and performance in school. Since then new medications specifically targeted towards ADHD have been placed on the market.
These drugs are Lisdexamfetamine mesylate (Vyvanse) and d-amphetamine:l-amphetamine (Adderall XR) (6)
The following image gives us a great idea of how the diagnosis of ADHD is distributed in the US
Here are some common facts you should know before learning more about these drugs.
- ADHD is a very commonly diagnosed behavioral disorder in children.
- Some 70% of these children diagnosed continue with the diagnosis into adolescence and adulthood.
- Amphetamines are the first line approach to treating ADHD
- Concerns regarding Amphetamine usage are numerous. The include and are not limited to
- Addiction and substance abuse
- Use of medication to create Methamphetamine.
- The medications have a short effect and have to be given multiple times each day. (5)
Before beginning here is a quick overview in which you can see that Adderall and Vyvanse are grouped together in the same type of medication.
Difference between Adderall and Vyvanse
- Vyvanse (lisdexamfetamine) was noted as the first prodrug approved for ADHD treatment. (6)
- Adderall had been pulled from the market due to a finding stating high risk for stroke and seizures. Shortly after in 2005 it was placed back on the market with stronger labeling and closer attention to dosage. (3) Health Canada suggested and applied various preventions to these adverse effects including doing a baseline ECG on all patients with a history of heart-related issues. (4)
- The extended-release version of Adderall for children six and older was approved by the FDA. This will help with one of the biggest issues of amphetamine use in children mentioned before. It is available in many dosage strengths so that it can be adjusted for each patient. (7)
Dosage and Strengths
- The Dosage for ADHD is 30 mg by mouth every morning. This can be increased by 10 to 20 mg every day almost every week. The dosage should not exceed 70mg a day.
- The Dosage for binge eating disorder starts at 30mg every day and can be increased by 20mg each week. The target dose is to be between 50-70 mg a day. The dosage should not go over 70mg each day.
- Should not be used for weight loss
2. Adderall has a greater variety of its forms including tablet vs capsule and the strengths of each. Below is a list of all the options available.
- Different milligram strengths in tablet form are:
2.5mg/2.5mg, 3.75mg/3.75mg, 5mg/5mg, 6.25mg/6.25mg, 7.5mg/7.5mg, 10mg/10mg, 15mg/15mg
- Different milligram strengths in tablet form are:
2.5mg/2.5mg, 5mg/5mg, 7.5mg/7.5mg, 10mg/10mg, 10mg/10mg,12.5mg/12.5mg, 15mg/15mg
3. Adderall dosages for ADHD are as follows
- 5 mg by mouth every day, this may be increased to 5-10mg per day every week. This dosage should never go over 40 mg every day or be divided into every eight hours.
- Extended release dosage is 20 mg by mouth every morning. This dose should not exceed 60mg every day.
4 . Adderall dosages for narcolepsy are as follows:
- Between 5-60mg by mouth every day. This may increase by 10mg every day every week. This dosage should never be more than 60mg every day or be broke into doses of every 4-6 hours.
The side effects of each are extremely similar but due to the difference in percentage here you can see the complete list of each. As you can note the percentages for adverse effects with Adderall are a bit higher.
- Pre-marketing studies showed more than 10% of patients noted the following adverse effects: Insomnia, headache, upper abdominal pain, and anorexia.
- Studies showed less than 10% of patients noted the following adverse effects: stunted growth development, Diarrhea, Irritability, Nausea, seizure.
- Studies showed less than 5% of patients noted the following adverse effects: Rash, Hyperhidrosis, increased heart rate and blood pressure, tics, vomiting, emotional lability, tremors, and dizziness.
- Post-marketing studies showed rare cases of chest pain, MI, ventricular hypertrophy, sudden death, stroke and Tourettes, blurred vision, fatigue, and allergic reactions including anaphylactic reactions.
- A black box warning was included advising against possible dependency ad abuse.
- During premarket studies than 20% of people reported the following:
abdominal pain, insomnia, weight loss, headache, and loss of appetite.
- During premarket studies show less than 10% of people reported the following:
Anxiety, dizziness, dyspepsia, emotional lability, fever diarrhea, dry mouth, fatigue, Nausea, tachycardia, infection, nervousness, vomiting, weight loss.
- After marketing other adverse effects have been reported.
- Palpitations and cardiomyopathy
- Psychotic episodes
- Blurred vision
- Constipation and other gastrointestinal disturbances.
- Allergic reactions
- Impotence and changes in libido, as well as frequent/prolonged erections
- Raynaud phenomenon and Rhabdomyolysis
If you or a family member have been diagnosed with either of the followings please be sure to consult your doctor. It is easily noticed that the contraindications for Vyvanse are much smaller than those for Adderall.
- Hypersensitivity to amphetamine drugs.
- Use of MAOI can cause a hypertensive reaction.
- Hypersensitivity to amphetamines
- Hypertension, glaucoma
- Cardiovascular disease
- MAO inhibitors
Patient education for both medications is the same. Please pay close attention to all precautions when taking either of these things.
- If this medication is not used correctly of for recreation reasons it can cause sudden death and cardiac issues.
- If you notice any chest pain or tightness, shortness of breath or syncope alerts your doctor immediately.
- Parents should monitor any aggressive or violent behaviors in children. If an increase is noted their doctor should be alerted.
- Growth in children between the ages of seven and ten should be monitored closely.
- This medication can be taken without regard to meal times.
- Afternoon doses may cause insomnia.
- Capsules can be opened and sprinkled over food or juice for easier access with children. But this should be eaten immediately and not left out or stored. (9)
- Consult your doctor if you show any of the adverse effects mentioned above.
- Do not engage in hazardous activities.
- There is a possibility that dependency may occur.
- Do not discontinue abruptly or without physicians consent.
- Advise your physician if an increase in aggressiveness or violence is noted.
- For children between seven and ten years of age closely monitor growth. (8)
It is the topic which discusses how the medication works in the body.
- Absorption of Vyvanse is rapid and peak time is within one hour. (9) Whereas the onset of Adderall is within 30-60 min and its peak is in 3 hours. The peak for Adderall XR is 7 hours. (8)
- Vyvanse is eliminated through the urine within less than an hour. (9) Adderall also metabolized by the liver and excreted in the urine stays in the system between ten and fourteen hours depending on age. (8)
- Both medications assist in the release of dopamine and norepinephrine and blocks catecholamines. (8,9).
Image source : https://www.sec.gov
Below are only a few of the representations available of Adderall XR, there the same doages available of Adderall and in tablet form. . Please be aware of what the many forms look like and the difference in their dosage.
See http://reference.medscape.com/drug/adderall-amphetamine-dextroamphetamine-342997 for the complete list. (8)
Adderall XR (10mg cap, extended release 24hr.
Adderall XR (20 mg capsule, extended release 24hr)
Adderall XR (30 mg capsule, extended relsease 24hr)
- As mentioned before abuse and dependency is one of the leading issues surrounding amphetamine use in children.
- Many college students who do not have an actual prescription to the medication use it frequently to study for exams and even for recreational purposes. Almost 7% of college students say they have abused Adderall in the past year. (2)
All patients should seek medical advice and prescription for these medications. This article is written with the purpose to assist in the understanding of the differences between the two medications.
Changes in ones dosage and form of medication can be dangerous when not done according to medical prescription. Please seek your physician before making any changes in dosage or form of medication.