Are expensive slow release medications like Concerta or Adderall XR better than traditional and cheaper stimulants?
Adderall XR and the Patent Problem
One of the problems for manufacturers of ADHD Medication such as Ritalin and Adderall is that anyone can make them. The stimulants used in them where discover 50 or more years ago and any patents on them ran out long ago. Generic version of Ritalin are very cheap to make which is why you can buy a month’s supply for about $26.
So how do the manufacturers make lots of money from an ADHD medication that anyone make? Simple, formulate it in a new way and patent the new technology. This is what Shire Pharmaceuticals did with Adderall XR and Novartis did with Ritalin LA and Ritalin-SR. These time release tablets cost two or three times as much as their generic equivalent.
What’s Different about Adderall XR?
Compared to the standard Adderall, Adderal XR contains a different mixture of stimulants that are processed at different speeds by the body. This gives Adderall XR, in theory, a longer lasting effect with a smoother trip to and from its peak effect. In addition Adderall XR contains is medication in two beads. These dissolve in the stomach at different rates, one almost immediately and the other after four hours. This allows the drug to have an effect for up to 12 hours.
With Ritalin, Novartis took a different track to Shire and Adderal XR. In addition to the standard Ritalin tablets they introduced Ritalin-SR (slow release) and Ritalin LA (long acting). The SR version is a just a normal Ritalin tablet that disolves more slowly in the stomach where as Ritalin LA is a capulet containing tiny beads of medication. These beads dissolve at different rates giving a more even release of the drug. With the Ritalin LA capulet you can sprinkle the contents on food if the child cannot swallow the pill. This may be an advantage over Adderall XR or Concerta which cannot be broken before being swallowed.
Both the Ritalin-SR and Ritalin LA have the same active ingredient, methylphenidate, as regular Ritalin tablets. The prescribed dose of the Ritalin-SR/LA should be equivalent to the total daily dose of standard Ritalin. The effect of the long acting and slow release is about eight hours compared to the 12 hours claimed for Adderall XR and Concerta.
Is Adderall XR Better Than Standard Adderall?
Standard Adderall tablets are known as instant release tablets as they are designed to take effect as quickly as possible. Whilst this is useful in situations when a quick impact is needed it does mean that additional doses will be required after a few hours. The big advantage of the slow release medication such as Adderall XR and Concerta is that they last up to twelve hours. This allows a child to be medicated before the start of the school day and for the medication to still be effective by the time child returns home at the end of the day. This avoids giving the child or the school nurse additional tablets to take at lunch time, reducing the risk of the child missing or abusing their medication.
The other main selling point of Adderall XR and the other tablets is its smoother trip to and from its peak effectiveness. Stimulants that quickly achieve full effectiveness and then quickly drop off have a higher risk of abuse and addiction. Cocaine is a classic example of the quick high and quick fall. The different formulations of the drugs, compared to instant release tablets, mean that Adderall XR is harder to misuse as they are less suitable to crushing and snorting or smoking.
Does Adderall XR Do What it Claims?
Simply put, yes. Adderall XR is just as effective in treating ADHD as standard Adderall tablets and it does remain effective for up to 12 hours. This appears to be true of other extended release medications. However this must be treated with caution. Most of the research has been done by the pharmaceutical companies themselves and was scored using subjective criteria. Whether your child should use Adderall XR compared to normal Adderall or one of the other time release medications is something you and your doctor need to discuss.
Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD.
Long-Term Tolerability and Effectiveness of Once-Daily Mixed Amphetamine Salts (Adderall XR) in Children With ADHD.