Strattera vs Vyvanse: Differences, Similarities, and Which One is Better For You

Attention deficit hyperactivity disorder (ADHD) can be effectively treated with Strattera or Vyvanse, both of which can alleviate the lack of focus, impulsivity, and restlessness of the disorder. Brand-name drugs like Strattera and Vyvanse are approved to treat ADHD, aiming to enhance academic, work, and social performance. Yet, they differ significantly in mechanism, use, side effects, and interactions. Comparing the two ADHD medicines, including their cost, will be our focus here.

RELATED: What is Strattera? | What is Vyvanse?

Conditions treated by Strattera and Vyvanse 

Strattera and Vyvanse have approval from the U.S. Food and Drug Administration (FDA) for the treatment of ADHD symptoms. Either can control the symptoms of ADHD for as long as the disorder persists. In addition to uses for ADHD, Vyvanse is FDA-approved for binge eating disorder in adults. Strattera is occasionally prescribed off-label for cataplexy and orthostatic hypotension. Cataplexy involves sudden muscle weakness linked to narcolepsy, while orthostatic hypotension causes temporary drops in blood pressure, leading to dizziness upon changing position.

Is Strattera or Vyvanse more effective?

When choosing between Strattera and Vyvanse for ADHD, one obvious factor to consider is their effectiveness. Unfortunately, there isn’t sufficient data from direct head-to-head comparison studies to help make decisions about effectiveness. Plenty of indirect comparisons can be made by looking at how each drug measured up against placebo (inactive tablets) in clinical trials. According to a 2018 meta-analysis of available studies in pediatric and adult ADHD patients, stimulants like Vyvanse seem to be more effective than non-stimulant medication like Strattera. Conversely, an analysis of trials in adult patients did not find much difference between ADHD treatments overall, but Strattera showed some advantages. 

Comparing the two treatments is tricky due to short-term studies on ADHD. This matters because the drugs work differently. 

As a CNS stimulant medication, Vyvanse works quickly by increasing the release of the neurotransmitters norepinephrine and dopamine. Once an adequate dose is achieved, effects are felt within hours. 

On the other hand, as an SNRI, Strattera works more slowly by gradually increasing norepinephrine levels. It may be a month or two before relief is obtained with Strattera. As a result, short-term studies could result in a more favorable view of Vyvanse and other stimulants.

Strattera and Vyvanse are not the only options to be considered for ADHD. Some others include: 

Amphetamine products

• Adderall (immediate-release mixed amphetamine salts)
• Dexedrine (dextroamphetamine)
• Adderall XR 
• Mydayis (extended-release mixed amphetamine salts)

Methylphenidate products

• Focalin (dexmethylphenidate)
• Ritalin (methylphenidate)
• Concerta (long-acting methylphenidate) 

Non-stimulants 

• Wellbutrin XL (bupropion)
• Qelbree (viloxazine)

Ultimately, a choice between ADHD drugs requires a dedicated conversation between you and your healthcare provider. Their medical advice will be crucial in developing a treatment strategy, including behavioral therapy and pharmacological methods. Efficacy is only one facet of the comparison between Strattera and Vyvanse.

RELATED: Considering an ADHD medication? Your guide to adult ADHD treatment

Coverage and cost comparison of Strattera vs. Vyvanse

Differences in drug costs may want to be considered when making treatment choices. While Strattera and Vyvanse are brand-name medications, they each have a generic version and may offer monetary savings. Strattera, as a brand-name product, retails for $560 for 30, 40 mg capsules, but with a SingleCare coupon for generic atomoxetine, the same amount of capsules can be priced at only $30. Similarly, the SingleCare coupon for lisdexamfetamine brings the price down to $90 from the cost of $560 for brand-name Vyvanse.

The generic versions are also more apt to be favored by insurers, meaning lower copayments. For example, Aetna’s Standard Control Plan drug formulary lists atomoxetine and lisdexamfetamine as available generics. However, it does not include the brand name Strattera and categorizes the brand name Vyvanse as non-preferred. 

Humana’s Medicare Managed Care formulary has atomoxetine classified as covered but not Strattera or brand or generic Vyvanse. Similarly, the Medicare Part D pricing tool states that Strattera is not covered by a plan from AARP. Still, atomoxetine may cost only $10 per month instead of $170 per month for Vyvanse and $130 per month for lisdexamfetamine. 

Whether privately insured or through Medicare, the copayment for drugs will vary depending on plan specifics. Out-of-pocket expenses can also change based on location and pharmacy. 

The availability of each option must be considered, too. Drug shortages are becoming all too common, particularly among ADHD medications. It can be frustrating not to be able to get your prescribed medicine. The FDA’s drug shortage database cites all generic manufacturers of lisdexamfetamine as having limited to no product availability as of April 2024. Likely demonstrating its lower popularity due to its higher price, brand-name Vyvanse is cited by its manufacturer, Takeda Pharmaceuticals, as being available at all dosages. No shortages of Strattera or atomoxetine were noted, meaning that generic atomoxetine may be the lowest-priced and most available product in this comparison.

Common side effects of Strattera vs. Vyvanse

Adverse effects are another differentiating point between Strattera and Vyvanse. Strattera’s most common side effects among adults were nausea, dry mouth, decreased appetite, fatigue, and insomnia. Similarly, lisdexamfetamine use in adults was marked by decreased appetite, insomnia, and dry mouth as the most common side effects of Vyvanse. Both can lead to serious side effects, too, like hypertension (high blood pressure) and tachycardia (elevated heart rate). The full list of adverse effects is too extensive to list here, but it is worth reviewing with your pharmacist or medical provider. In the meantime, you can learn about how often adults taking each drug experience common side effects.

Source: Strattera and Vyvanse drug labels

Even after comparing efficacy, cost, and side effects, there is more to consider when figuring out if Strattera or Vyvanse is the right choice for you. Your list of other prescription drugs, over-the-counter medications, and supplements could be important. Both ADHD medicines can interact with other drugs, meaning that there may be one that you need to avoid or exercise particular caution with.

Drug interactions of Strattera vs Vyvanse

Vyvanse could exacerbate the side effect potential of other drugs, notably medications that increase seizure risk or serotonin level. This includes a lengthy list of antidepressant and antipsychotic medicines. Vigilance is needed in watching out for these interactions because other mental health disorders and ADHD often coexist, and the outcomes of an interaction can be serious. They can result in seizures and serotonin syndrome, marked by fever and rigidity. Vyvanse can also negate the effects of antihypertensives, leading to higher blood pressure.

Strattera can have an additive effect with other drugs that prolong the QT interval of the heart’s electrical conduction system. The list of QT-prolonging drugs is extensive and includes a host of antidepressants. Prolonging the QT interval can trigger a life-threatening heart arrhythmia. Numerous interactions exist, some of which are listed below, so you should review your entire drug list with a healthcare professional before starting any prescription.

Warnings of Strattera and Vyvanse

The FDA also has something to say about the decision to take Strattera or Vyvanse. Both drugs have a black box warning from the regulatory agency. Strattera’s label calls attention to a heightened risk of suicidal thoughts among children and adolescents taking the drug, particularly in the first month of treatment. The incidence of this adverse effect is listed as 0.4% on the label. Other warnings call attention to the potential for cardiovascular side effects, psychosis, liver injury, and behavioral changes.

The potential for addiction, abuse, and misuse of Vyvanse is highlighted in the warning on its label. Overdose and death can occur with abuse and misuse. For these reasons, Vyvanse is considered a controlled substance by the Drug Enforcement Administration (DEA). Although not contained within the black box warning, general cautionary notes with Vyvanse include cardiovascular side effects, growth suppression in children, exacerbation of tics, and psychosis.

Use of Vyvanse during pregnancy or breastfeeding can have adverse effects on the fetus or infants. Information on the effects of Strattera on fetal development and breastfed infant health is very limited. Alternatives to either Vyvanse or Strattera may be recommended by an individual’s healthcare provider. Medical professionals will consider one’s overall health when deciding which medication is best.

Frequently asked questions about Strattera vs. Vyvanse

Are Strattera and Vyvanse the same?

Although Strattera and Vyvanse are FDA-approved for ADHD treatment, they differ significantly in their therapeutic approaches. Strattera is an SNRI that needs to be taken daily and provides relief in 1-2 months. Vyvanse is a CNS stimulant that works within hours, does not need to be taken daily, and has the potential for abuse.

Is Strattera or Vyvanse better?

The specifics of one’s ADHD symptoms, coinciding health problems, past medical history, and concurrent medications may make one medicine preferable to another. Otherwise, without strong clinical studies comparing both treatments, we can’t determine which drug is better overall.

How can I switch from Vyvanse to Strattera?

Changing from Vyvanse to Strattera, or vice versa, must be done with the careful guidance of a medical doctor and pharmacist. A taper down and off one drug, followed by initiation of the other, may be advised. Taking STrattera and Vyvanse together is avoided due to the potential for adverse effects like blood pressure elevation.