If you have been diagnosed with ADHD in the UK, the first medication you are offered is likely to be one of two: Elvanse (lisdexamfetamine) or a long-acting form of methylphenidate, such as Concerta XL. Both are well established, both are recommended by national guidance, and both work for many people. They are not the same, though, and it helps to understand how they differ before you start.
This guide explains what each medicine is, how they compare, what the guidance says and how your prescriber will decide which to try first.
No ADHD medicine suits everyone, and finding the right one can take a few weeks.
The short answer
Elvanse and Concerta XL are both stimulant medicines taken once in the morning. Elvanse capsules contain lisdexamfetamine, which the body converts into dexamfetamine. Concerta XL is a tablet that releases methylphenidate gradually through the day. NICE recommends either as a first choice for adults, and methylphenidate as the first choice for children aged 5 and over.
Neither is better for everyone. People respond differently, and if the first medicine does not work well enough, NICE suggests trying the other.
What is Elvanse?
Elvanse contains lisdexamfetamine. It is a “prodrug”, which means it is inactive when you swallow it. Once in the body, it is converted, mainly in the blood, into dexamfetamine, which is the active medicine.
In clinical studies described in the Elvanse product information, its effects were still present 13 hours after a dose in children and 14 hours in adults. How long it lasts for you may be different.
What is Concerta XL?
Concerta XL contains methylphenidate, one of the most widely used ADHD medicines in the UK. The tablet has a small immediate-release portion on the outside and a slow-release core, so it starts to work in the morning and continues to release medicine through the day. In clinical studies described in the Concerta XL product information, its effects lasted up to 12 hours after a dose.
Several other long-acting methylphenidate tablets are available in the UK, such as Xaggitin XL and Delmosart. They are not always interchangeable, because their release patterns can differ, which is why long-acting methylphenidate is usually prescribed by brand. If your pharmacy offers a different brand, check with your prescriber.
Elvanse vs Concerta at a glance
- Active medicine. Elvanse: lisdexamfetamine, converted to dexamfetamine. Concerta XL: methylphenidate
- Form. Elvanse: capsule. Concerta XL: tablet, which should be swallowed whole
- How often. Both are taken once a day, in the morning
- Duration in studies. Elvanse: effects still present at 13 hours in children and 14 hours in adults. Concerta XL: up to 12 hours. These come from separate studies, so they are not a direct comparison
- NICE first choice. Adults: either. Children aged 5 and over: methylphenidate first
- Controlled drug. Both are controlled medicines, with stricter prescription rules than most medicines
For a wider look at the options, including non-stimulant medicines, see our guide to which medications help with ADHD.
What NICE recommends
The national guideline on ADHD, NICE NG87, sets out the order in which medicines should usually be tried.
For adults, NICE recommends offering lisdexamfetamine or methylphenidate as the first-line medicine. If one has been tried for 6 weeks at an adequate dose without enough benefit, NICE suggests considering a switch to the other.
For children aged 5 and over and young people, NICE recommends methylphenidate first. Lisdexamfetamine is considered if a 6-week trial of methylphenidate at an adequate dose has not helped enough. Most of these medicines are licensed from age 6, so treatment at age 5 would be outside the licence, which a specialist would discuss with you.
A large 2018 analysis of ADHD medication trials by Cortese and colleagues, published in The Lancet Psychiatry, reached a similar conclusion for children, and for adults it favoured amphetamine-based medicines. Taking both effectiveness and side effects into account, it supported methylphenidate for children and young people, and amphetamine-based medicines for adults, as the preferred first choices for short-term treatment. It looked at short-term trials, so it does not tell us which works better over many years.
Side effects
Because both are stimulants, many of the possible side effects are the same. According to the product information, common side effects of both can include:
- Reduced appetite
- Difficulty sleeping
- Headache
- Faster heart rate and raised blood pressure
- Feeling anxious or irritable
Dry mouth and weight loss are also listed as common. Side effects are often worst in the first few weeks and may ease as your body adjusts or your dose is changed. Some people find one medicine suits them better than the other, but there is no reliable way to predict this in advance. Tell your prescriber about any side effects, rather than stopping the medicine on your own.
If you have chest pain, fainting, a racing or irregular heartbeat, or sudden changes in mood or unusual thoughts, get urgent medical help by calling 999 or NHS 111.
If sleep becomes a problem, our guide to ADHD and sleep problems has practical suggestions.
How your prescriber chooses
The choice depends on more than the guideline. Your prescriber will usually consider:
- Your age, and whether you have taken ADHD medication before
- How long you need the effect to last, for example for a long working day or evening study
- Your physical health, including your heart, blood pressure and any other medicines you take
- Other conditions, such as anxiety, tics or a mood disorder
- Whether you can swallow tablets whole. Elvanse capsules can be opened and the contents mixed with soft food or water, but Concerta XL must be swallowed whole
- Your own preferences, once you understand the options
If you are still deciding whether to take medication at all, our guide to whether to take ADHD medication sets out the questions to think about.
Checks before and during treatment
Before you start either medicine, NICE recommends a review of your physical and mental health. This includes your height and weight, pulse and blood pressure, a cardiovascular assessment and your medical history. An ECG is not routinely needed unless there is a specific reason, for example certain heart conditions or symptoms, a family history of sudden cardiac death at a young age, or taking other medicines that can affect the heart.
Once you are taking medication, NICE recommends checking your heart rate and blood pressure before and after each dose change and every 6 months.
Starting and adjusting the dose
Whichever medicine you start, the dose is increased gradually until the benefits are as good as possible without troublesome side effects. This is called titration, and it usually involves regular reviews over several weeks. Our guide to what to expect during ADHD titration explains the process, and you can book a titration appointment with our team.
Once your dose is stable, your care may be shared with your GP. Our article on shared care agreements explains how that works.
Switching between Elvanse and Concerta
Switching is common and is part of finding the right treatment. NICE suggests considering a switch if a 6-week trial at an adequate dose has not helped enough. Some people also switch because of side effects, or because they need a shorter or longer effect.
Do not switch, stop or change the dose yourself. Your prescriber will plan any change and review how you get on.
Practical things to know
- Prescriptions: both are controlled drugs, so prescriptions must be collected within 28 days of being written
- Alcohol: the Concerta XL product information advises avoiding alcohol, and there is limited information on how alcohol interacts with Elvanse. Our article on ADHD and alcohol covers this in more detail
- Driving: it is an offence to drive if your ability is impaired. Our guide to ADHD, driving and DVLA rules explains what you need to know
- Travel: if you take controlled medicines abroad, carry a letter from your prescriber and check the rules of the country you are visiting
What about Adderall?
Adderall, a mixture of amphetamine salts widely used in the United States, is not licensed in the UK. The amphetamine-based options available here are lisdexamfetamine (Elvanse) and dexamfetamine. Our guide to UK alternatives to Adderall explains the options.
Conclusion
Elvanse and Concerta XL are both effective, recommended first choices for ADHD, and the main differences are the active medicine, how it is released and how long it lasts. The right one for you depends on your age, health, routine and how you respond, which is why careful titration and regular review matter so much.
Read more about our ADHD medication service, or contact our team if you would like to talk through your options.
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