Focalin vs. Vyvanse: Prescription Treatment for ADHD

An estimated one in every ten children in the United States is believed to have attention deficit hyperactivity disorder, or ADHD. This common neurodevelopmental disorder can affect individuals throughout their lifetimes, potentially creating difficulty managing their behavior in a variety of different situations. 

Patients looking for a prescription ADHD medication may be curious to know about the differences in Focalin vs. Vyvanse, two common prescriptions for ADHD.

Overview

Focalin and Vyvanse belong to a class of drugs called central nervous system stimulants. The active ingredient in Focalin is dexmethylphenidate hydrochloride, while the active ingredient in Vyvanse is lisdexamfetamine. 

Focalin is available in both an immediate release and long-acting extended-release formulations and as a generic and brand name drug in each form, while Vyvanse is only available in its brand name form and in one formula. 

Central nervous system stimulants like Focalin and Vyvanse act on neurotransmitters in the brain that are associated with hyperactivity and impulsiveness, such as dopamine, and provide a calming effect.

The U.S. Drug Enforcement Administration (DEA) has classified both Focalin and Vyvanse as Schedule II controlled substances because both drugs have a very high potential for abuse and addiction. Schedule II is the highest level of control that can be given to a drug with medical applications.

Conditions Treated

Focalin and Vyvanse are approved by the U.S. Food and Drug Administration (FDA) for the treatment of attention deficit hyperactivity disorder, commonly known as ADHD. Vyvanse is also approved by the FDA for the treatment of binge eating disorder. Focalin is sometimes prescribed off-label for the treatment of narcolepsy, but the FDA has not approved the medication for this purpose.

Attention Deficit Hyperactivity Disorder

ADHD is a common neurodevelopmental disorder that is typically diagnosed in children marked by low levels of norepinephrine. 

ADHD diagnosis rates have skyrocketed in children in the United States in the past several decades, although the condition has been known to exist for centuries. While childhood diagnosis of the condition is the most common, some people are not diagnosed until adulthood or do not experience symptoms until adulthood, a condition known as adult-onset ADHD. While most people diagnosed with ADHD experience symptoms of the disorder throughout their lifetimes, some people find that their symptoms become less noticeable as they age.  

It is common for a patient’s symptoms and presentation to change throughout their lifetime. Common signs and symptoms of ADHD include: 

• Difficult controlling impulsive behaviors
• Hyperactivity
• Impulsivity
• Talking excessively
• Squirming or fidgeting
• Making careless mistakes
• Forgetting or losing things regularly
• Difficulty resisting temptation
• Daydreaming
• Difficulty getting along with others
• Difficulty paying attention

Both Focalin and Vyvanse are approved for the treatment of ADHD in adults and children ages six and older.  

Cost

Focalin and Vyvanse are brand name prescription drugs. One significant difference between the two medications is that Focalin is available in generic and brand name forms for both Focalin and Focalin XR, while Vyvanse is not available in a generic form. This contributes to a significant cost difference between the two medications, as the cost of the medications is substantially reduced when the drugs are purchased in the generic forms.

The cost of Focalin varies depending on whether the medication is purchased in its short-acting immediate release or extended release tablets. 

The immediate release brand name version of Focalin is considered affordable for a brand name prescription, as it can be purchased at a cost of approximately $48 for a one month prescription.  

The generic version of Focalin and Focalin XR, dexmethylphenidate, can be obtained for less than $20 for a monthly prescription. 

By contrast, the extended release form of Focalin, brand name Focalin XR, costs about $408 for a monthly prescription. 

Vyvanse is not available in a generic form and is thus considerably more expensive than the generic versions of Focalin and Focalin XR and the brand name Focalin, although it is slightly less expensive than brand name Focalin XR. A 30-day supply of Vyvanse costs approximately $373 regardless of the strength of the drug. 

Side Effects

Focalin and Vyvanse are both associated with a lengthy list of side effects, some of which can be serious and may require medical attention. 

While most patients taking Focalin or Vyvanse who experience side effects will find that their side effects are the most noticeable when they first start taking the drug or when their dose is increased and gradually diminish over time, others may find that their bodies do not adjust to the medication, and side effects are experienced for the duration of treatment.  

If you experience side effects that are prolonged or severe in nature, make sure to contact your doctor for medical advice, or seek medical attention immediately. 

Focalin

Children and adults experience slightly different common side effects associated with the use of Focalin and Focalin XR. 

Common side effects of Focalin and Focalin XR reported in children between the ages of 6 and 17 years of age include:

• Decreased appetite
• Dyspepsia (indigestion)
• Headache
• Anxiety

Common side effects of Focalin and Focalin XR reported in adults include:

• Dry mouth
• Pharyngolaryngeal pain (pain in the back of the mouth or the throat)
• Dyspepsia (indigestion)
• Headache
• Anxiety

Serious side effects associated with the use of Focalin and Focalin XR include:

• Unexplained wounds on the fingers or toes
• Slowing of growth (height or weight) in children using Focalin
• Priapism (painful or prolonged erections) in both adults and children
• Circulation problems in the fingers or toes, including the development of peripheral vasculopathy or Raynaud’s phenomenon

Patients who see any of the serious side effects associated with Focalin above should seek medical attention from a healthcare professional immediately. 

Vyvanse

Vyvanse is associated with side effects that range from common to less common and may differ depending on the medical condition that is being treated. 

Common side effects associated with treatment of ADHD in children and adults include:

• Irritability
• Loss of appetite
• Decreased appetite
• Weight loss
• Diarrhea
• Upper stomach pain
• Anxiety
• Dry mouth
• Dizziness
• Vomiting
• Nausea
• Trouble sleeping
• High blood pressure

Common side effects associated with treatment of moderate to severe BED include:

• Dry mouth
• Increased heart rate
• Anxiety
• Trouble sleeping
• Constipation
• Feeling jittery
• Decreased appetite

Less common side effects associated with Vyvanse that may occur regardless of the condition treated include:

• Libido changes
• Rapidly changing moods
• Depersonalization
• Agitation
• Sleepiness or unusual drowsiness
• Rash
• Trouble breathing

Potential for Abuse and Addiction

As Schedule II controlled substances, both Focalin and Vyvanse are associated with a high risk of abuse and addiction. The medications both carry a black box warning due to the high risk of dependence on the drugs. Focalin and Vyvanse are most commonly abused by people who do not have a prescription for the medication but who want to improve their focus or concentration for a short period of time, such as while studying for a test or during a busy time at work.   

People who take the medications with no medical need or at high doses for an extended period of time are more likely to develop a dependence on the drugs. 

Symptoms of dependence may include:

• Anxiety
• Depression 
• Sweating
• Nausea
• Body aches
• Vomiting 
• Nightmares
• Muscle weakness

Withdrawal

Withdrawal symptoms are likely to occur in people who become dependent on Focalin or Vyvanse and discontinue the use of the medication or dramatically reduce their dose in a short period of time. 

Patients who have been taking Focalin or Vyvanse for a period of more than two weeks should only discontinue use of the drug or reduce their dose under the supervision and guidance of their prescribing physician. 

Withdrawal symptoms associated with the discontinuation of Focalin and Vyvanse can include:

• Cravings
• Anxiety
• Sleep disturbances
• Increased appetite
• Shaking
• Fatigue
• Changes in mood
• Sweating
• Depression
• Agitation
• Strange dreams

Summary

ADHD is a common neurodevelopmental disorder in children and some adults that can be effectively treated with the use of prescription central nervous system stimulants like Focalin and Vyvanse. 

Focalin and Vyvanse can be used to treat ADHD in adults and children ages six and older, and Vyvanse is also approved for the treatment of binge eating disorder. Other drugs such as Adderall XR, Ritalin, methylphenidate, Dexedrine, Concerta, and daytrana are also stimulant medications prescribed by mental health professionals as ADHD treatment options. 

Focalin is available in both brand name and generic forms in both an immediate release and extended-release formula, while Vyvanse is available only in a brand name version in one standard formula. 

Both medications can be costly in their brand name forms, but brand name Focalin is less expensive than brand name Vyvanse. 

Although the brand name forms of each drug can be expensive, it’s possible to save money on all FDA-approved generic and brand name prescription medications regardless of your insured status by using a pharmacy discount card from Pharmacists.org.

Sources:
https://www.cdc.gov/ncbddd/adhd/data.html 
https://www.webmd.com/drugs/2/drug-22256/focalin-oral/details 
https://www.novartis.us/sites/www.novartis.us/files/focalinXR.pdf 
https://www.vyvanse.com/ 
https://www.cdc.gov/ncbddd/adhd/facts.html