Concerta alternatives: What can I take instead of Concerta?

Compare Concerta alternatives | Daytrana | Adderall XR | Strattera | Kapvay | Intuniv | Natural alternatives | How to switch meds

The stigma around mental health, unfortunately, remains prevalent and adds a difficult component to managing living with one to any of those suffering. One Attention Deficit Disorder (ADD), Attention-deficit hyperactivity disorder (ADHD), is a common mental health condition. It is characterized by inattention, hyperactivity and impulsivity and is one of the most common reasons children are referred to receive mental health services. However, there is now a growing understanding that ADHD can continue into adulthood for many people. In addition, the diagnosis of ADHD in adults may go unidentified since it differs from that in children due to many different symptoms. We know that ADHD is a lifespan disorder, and while treatment plans designed by healthcare professionals include many non-pharmacologic approaches, medication is often a component of that plan. 

Concerta (methylphenidate, extended-release) is a central nervous system stimulant (CNS) that induces dopamine release and is prescribed to treat ADHD, and other conditions including severe fatigue in a cancer-related or palliative setting, major depressive disorder in certain patient populations, as well as narcolepsy. Dosing of Concerta for these indications is highly individualized. While the active ingredient of Concerta, methylphenidate, is available in many ADHD prescription drugs and may be recommended as first-line therapy, patients not responding to one med may respond to another.

RELATED: What is Concerta?

What can I take in place of Concerta?

There are other options in the treatment of ADHD besides brand name Concerta. Most alternative prescription medications include other types of central nervous system stimulants, which include methylphenidate, dexmethylphenidate, serdexmethylphenidate/dexmethylphenidate, and amphetamines as their main ingredients. Where methylphenidate induces dopamine release as its main mechanism of action, amphetamines block the reuptake and increase the release of serotonin, norepinephrine, and dopamine. Both methylphenidate and amphetamine salts are examples of Schedule II controlled substances per the Food and Drug Administration (FDA). Patients not responding to one stimulant may respond to another, and doses are usually initiated at lower doses and then titrated slowly. 

Common side effects associated with stimulants—despite active ingredient(s)—are similar, and include weight loss, anorexia, and insomnia (among others). They also are contraindicated during or within 14 days of MAOI therapy and serotonin syndrome could occur when used with other medications which mimic or increase serotonin. Concerta specifically can cause tachycardia, or a fast heart rate. It is available as a special type of tablet that cannot be crushed, which may limit its use in certain patients. Non-stimulant medications are available which some caregivers may be more comfortable with giving their children or taking themselves. Also, some patients turn to non-stimulants because they respond poorly to stimulants, or they are used as adjunctive therapies to a stimulant regimen. Ultimately, the various options may be more suitable for certain individuals due to their different uses, side effect profiles, dosages, administration, and even cost. 

Other alternatives to Concerta

• Methylin (immediate-release methylphenidate, chewable tablets or oral solution)
• Focalin (immediate-release dexmethylphenidate)
• Focalin XR (extended-release dexmethylphenidate)
• Aptensio XR (extended-release methylphenidate)
• Cotempla XR-ODT (25% immediate-release and 75% extended-release methylphenidate orally-disintegrating tablets)
• Jornay PM (extended-release methylphenidate)
• Relexxii (extended-release methylphenidate)
• Ritalin LA (50% immediate-release and 50% extended-release methylphenidate)
• QuilliChew ER (30% immediate-release and 70% extended-release methylphenidate)
• Quillivant XR (20% immediate-release and 80% extended-release methylphenidate)
• Azstarys (serdexmethylphenidate and dexmethylphenidate)
• Adderall (mixed amphetamine salts)
• Adzenys XR-ODT (extended-release amphetamine orally disintegrating tablets)
• Adzenys ER (extended-release amphetamine oral suspension)
• Zenzedi (dextroamphetamine)
• Dexedrine Spansule (dextroamphetamine)
• Dyanavel XR (extended-release amphetamine oral suspension)
• Evekeo (1:1 ratio of dextroamphetamine/amphetamine)
• Evekeo ODT (1:1 ratio of dextroamphetamine/amphetamine orally-disintegrating tablets)
• Mydayis (extended-release mixed amphetamine salts)
• ProCentra (dextroamphetamine)

Top 5 Concerta alternatives

The following are some alternatives to Concerta.

1. Daytrana

Daytrana contains methylphenidate but is delivered in a transdermal patch for a steady effect and may be preferred in those that do not want to or unable to take medications by mouth. The patch is applied once daily in the morning for 9 hours approximately 2 hours before the desired effect and can be worn up to 16 hours if a longer effect is needed. It should be removed at least 3 hours before bedtime to allow the body to metabolize the medication and minimize the risk of insomnia. 

2. Adderall XR

Adderall XR (amphetamine-dextroamphet ER) works slightly differently than methylphenidate and may be an option for those unable to tolerate some of the side effects of Concerta, like elevated heart rate or sweating. However, this medication also comes with some limitations of use. Amphetamine-containing ADHD medications are contraindicated in patients with heart problems, including advanced arteriosclerosis, symptomatic cardiovascular disease, and moderate to severe hypertension. Even though it is extended-release, the capsules can be either swallowed whole or opened and sprinkled on applesauce so may be a good option for children unable to take capsules. 

3. Strattera

Strattera (atomoxetine) is a non-stimulant medication that may be used as an adjunct to stimulants, in patients who respond poorly to stimulants, or if caregivers/patients are uncomfortable with the idea of taking stimulant medications. Strattera is also not a controlled substance. The response rate for controlling ADHD symptoms is lower with this medication than with other alternatives, but it may be a good option for patients with other conditions including anxiety, tics, insomnia, or substance abuse disorders. Since methylphenidate-containing medications should be avoided in patients with a history of Tourette’s syndrome, this medication may be a good alternative in patients with this diagnosis. Strattera does contain a black box warning for increased suicidal ideation in children and adolescents. This medication is taken either once daily or in divided doses twice daily—for example, once in the morning and once in the late afternoon or early evening. Kapvay

4. Kapvay

 Kapvav is another non-stimulant alternative to Concerta available as extended-release tablets. This medication may be a good option for children who are unable to tolerate stimulants, such as those with tics or insomnia at baseline. This medication may pose a problem for younger kids since it is only available as a tablet which cannot be crushed, chewed, or broken before swallowing. It cannot be substituted for other clonidine products (e.g., patches, immediate-release tablets) on a mg-per-mg basis. When doses exceed 0.1mg/day, they should be divided into twice daily dosing with an equal or higher split dosage being given at bedtime. 

5. Intuniv

Intuniv (guanfacine extended-release) has also demonstrated to be at least as effective as stimulants and serves as a good option for those unable to tolerate stimulants or patients with underlying anxiety and aggression. This medication should be taken once daily at approximately the same time each day, but cannot be crushed, chewed, or broken. Intuniv can also not be substituted for immediate-release guanfacine tablets on an mg-per-mg basis due to differences in the way the body handles the medication. If discontinuing Intuniv, it should be tapered in increments of 1mg every 3 to 7 days, or else one might experience withdrawal symptoms. 

Natural alternatives to Concerta

As mentioned previously, treatment plans for ADHD can include non-pharmacologic options, such as behavioral interventions. In fact, this approach should be trialed before medications in children younger than 6 years old and is also important in children younger than 12 as part of a multimodal strategy toward management of the condition. Other approaches for management might include some nutritional supplementation with polyunsaturated fatty acids, iron, zinc, or magnesium. Overall, the effect of these natural alternatives are minimal compared to effect sizes seen with traditional prescription medication. 

RELATED: Everything to eat (and avoid) if you have ADHD

How to switch to a Concerta alternative

When converting patients from one agent to another for the treatment of attention-deficit disorders, a degree of clinical judgment and experience along with monitoring the patient closely for clinical and adverse effects should be employed. There are conversion recommendations available to make sure symptoms of ADHD remain consistently controlled. For example, many people initiated on an immediate-release formulation of methylphenidate are ultimately converted to an extended-release formulation like Concerta for convenience and less breakthrough symptoms. This conversion generally doesn’t require any titration like when initiating therapy—basically, one would start at a dose close to, but which does not exceed the effective total methylphenidate daily dose. 

When converting from Concerta to the methylphenidate transdermal patch, Daytrana, titrations are required—an mg-to-mg cannot be directly substituted. For example: Concerta 18 mg 🡪 Daytrana 10 mg (12.5 cm2), Concerta 27 mg 🡪 15 mg (18.75 cm2), Concerta 36 mg 🡪 Daytrana 20 mg (25 cm2), and Concerta 54 mg 🡪 Daytrana 30 mg (37.5 cm2). 

Conversion between methylphenidate and dextroamphetamine/mixed amphetamine salts is more challenging; no specific guidelines in the literature exist. Amphetamines are dosed at approximately half the methylphenidate, so if converting from Concerta to Adderall XR consider starting at half the dose and titrating up as needed. 

If it’s decided to stop taking Concerta entirely, it must be tapered slowly to avoid withdrawal-like symptoms, and should always be done per the schedule provided by a healthcare professional and under direct medical advice.