The medications Concerta and Adderall contain different active ingredients, but both have U.S. Food and Drug Administration-approved indications for treating attention-deficit/hyperactivity disorder in children and adults. Concerta, which Ortho McNeil Janssen markets in tablet form, contains the stimulant methylphenidate. Adderall also comes as a tablet, but it contains a mix of amphetamine salts and is marketed by Shire. Patients take higher daily doses of Concerta than Adderall, but patients take Adderall more often than Concerta. Both medications have the potential for causing addiction and for being abused.
Concerta Daily Dose
Patients take Concerta once per day. The medication’s prescribing information recommends that all children start treatment with an 18-mg dose of Concerta; adults can initiate treatment with an 18-mg or 36-mg dose. If children do not show improvement when taking 18 mg of Concerta and do not experience serious side effects from the medication, they can begin taking daily doses of 36 mg or 54 mg. Adults who need more medication---and can take more safely---can have their daily dose of Concerta raised to 72 mg. Doctors should prescribe daily dosing increases in increments of 18 mg.
Concerta Dosing Tips
Patients should swallow Concerta tablets whole and wash their tablets down with a glass of water or other nonalcoholic beverage. Patients can take the tablet with or without food. Children should never take more than 54 mg of Concerta in a 24-hour period, and adults should never take more than 72 mg of Concerta in a 24-hour period. Signs and symptoms of a Concerta overdose include muscle twitches, convulsions, vomiting, extreme agitation, racing heartbeat, mental confusion and hallucinations.
Concerta Warnings and Side Effects
The prescribing information for Concerta carries a boldfaced, boxed warning that sates, in part, “Should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior.” Children younger than 6 years should not take Concerta, and no person of any age should take Concerta if she has an anxiety disorder, a tic disorder or glaucoma. Patients need to stop taking antidepressant medications classified as monoamine oxidase inhibitors, or MAOIs, for at least 2 weeks before starting to take Concerta. Commonly prescribed MAOIs include isocarboxazid (Marplan from Validus) and selegiline (e.g., Zelapar from Valeant). The most common side effects among children taking Concerta have been pain in the upper part of the stomach, vomiting, fever, sore throat, nasal irritation, loss of sleep and dizziness. Adults taking Concerta have most often reported loss of appetite, insomnia, increased anxiety and irritability, headache, dry mouth, weight loss and excessive sweating as side effects from the medication.
Adderall Daily Dose
Patients older than 6 years take Adderall twice or three times each day. The recommended starting dose of Adderall for children younger than 6 years is 2.5 mg per day. Older children and adults can take 5 mg of Adderall once or more each day when they begin treatment and can have their dosage raised to 40 mg per day if needed and if serious side effects do not occur. Daily dosing increases should come in increments of 2.5 mg or 5 mg.
Adderall Dosing Tips
Patients should take their first Adderall tablets upon waking in the morning. Patients can take Adderall while eating a meal or snack, but they should not take Adderall shortly before going to bed. The prescribing information for Adderall advises prescribers to periodically take patients off the medication to assess whether patients continue to need Adderall to control their attention-deficit/hyperactivity disorder and to minimize the risk that patients will become dependent on the medication. Patients should generally not take more than 40 mg of Adderall each day. Overdoses of the medication can cause jumpiness, rapid breathing, panic, aggressiveness, hallucinations, tremor, dangerous drops or increases in blood pressure, vomiting, diarrhea and convulsions.
Adderall Warnings and Side Effects
Like Concerta, Adderall has prescribing information that warns about the medication’s potential for abuse and dependence and states that it cannot be taken at the same time as an MAOI. Unlike Concerta, Adderall can be prescribed to children as young as 3 years. Adderall cannot be used by any patients with hardened arteries, cardiovascular disease, high blood pressure, a tic disorder or an anxiety disorder. A small number of patients have died suddenly after taking Adderall. More common side effects from Adderall use include rapid heartbeat, insomnia, dizziness, dry mouth, complete loss of appetite and high blood pressure.