Vyvanse or Adderall?

Attention deficit disorder, inattentive type, marked by poor concentration, disorganization, forgetfulness, poor task completion, and inadequate reading comprehension, may be missed in childhood because these children demonstrate no hyperactivity or class disruption. Once the diagnosis is made, a psychostimulant is often prescribed, usually Adderall.

Adderall (mixed amphetamine salts) and Vyvanse (lisdexamfetamine) are stimulants used to treat ADD. Initially, Vyvanse was very expensive because Takeda Pharmaceuticals had the patent. When lisdexamfetamine became available as a generic, accessibility made it a viable choice.

The absorption of lisdexamfetamine was assumed to occur in the GI tract, but we now know the cleavage occurs in red blood cells. The delay in activation means that snorting or injecting lisdexamfetamine results in much lower abuse potential compared to other amphetamine formulations. Abuse rates of lisdexamfetamine are lower than those of mixed amphetamine salts (Adderall).

Lisdexamfetamine has a longer half-life and causes fewer side effects like motor tics and cardiovascular effects. Many patients report a “smoother experience” taking lisdexamfetamine compared to mixed amphetamine salts (Adderall). Activation in the red blood cells is much more consistent than absorption in the GI tract, which means that the levels of lisdexamfetamine are less affected by food, gut pH, or bariatric surgery. Extended-release beads of mixed amphetamine salts (Adderall XR) are delayed more by a heavy meal (around two and a half hours) than lisdexamfetamine (around one hour).

A network of meta-analysis of treatments identified amphetamines as the most effective treatments for ADD in adults. In this class, lisdexamfetamine appears to be the most effective amphetamine (it had the highest difference from placebo).