Vyvanse vs Adderall: A Psychiatrist's Treatment Decision Guide

By Dr. Ryan Sultan, Assistant Professor of Clinical Psychiatry, Columbia University | Updated February 2026

🧠 The Basic Science: What Are These Medications?

Let's start with what they have in common.

Both Vyvanse and Adderall are amphetamine-based stimulants that increase dopamine and norepinephrine in your brain. This improves focus, attention, impulse control, and executive function.

But here's where they differ:

Adderall (Amphetamine Salt Combo)

• What it is: A mixture of four amphetamine salts (dextroamphetamine and levoamphetamine)
• How it works: Directly releases dopamine and norepinephrine immediately after you take it
• Formulations: Comes in immediate-release (IR) and extended-release (XR) versions
• Approval: FDA-approved since 1996 for ADHD

Vyvanse (Lisdexamfetamine)

• What it is: A "prodrug" that combines dextroamphetamine with the amino acid lysine
• How it works: Your body must convert it to active dextroamphetamine in your bloodstream
• Formulations: Only comes in extended-release capsules (no immediate-release version)
• Approval: FDA-approved since 2007 for ADHD, 2015 for binge eating disorder

⏱️ Duration and Onset: The Biggest Practical Difference

This is where most of my patients notice the real-world difference.

What This Means in Real Life

Vyvanse patients typically report:

• "I don't feel it kick in as obviously, but I realize hours later that I've been focused all day"
• "It lasts through dinner time, which helps with evening tasks"
• "The comedown is much gentler – I don't crash"
• "Sometimes it takes too long to start working in the morning"

Adderall patients typically report:

• "I feel it working within 30 minutes, which helps me start my day"
• "With XR, I sometimes feel a second 'boost' in the afternoon"
• "I can take IR for specific tasks and skip it on weekends"
• "The afternoon crash can be rough if I don't time my dose right"

💊 Effectiveness: Does One Work Better?

Here's what the research actually shows.

The short answer: They're equally effective when dosed correctly.

A 2013 meta-analysis in CNS Drugs found no significant difference in efficacy between different long-acting stimulants for ADHD. What matters more is:

• Finding the right dose
• Taking it consistently
• Managing side effects so you can stay on it

Response Rates

Both medications have approximately:

• 70-80% response rate (significant symptom improvement)
• 10-30% non-response rate (minimal or no benefit)
• Similar effect sizes on ADHD rating scales

Individual Variation

Here's the catch: your response might be completely different from someone else's.

Some people respond beautifully to Vyvanse and find Adderall too "speedy."

Others find Adderall clear and focusing, while Vyvanse feels "blunted" or "flat."

We don't yet have a genetic test or biomarker that predicts which one you'll respond to better. That's why treatment involves some trial and error.

⚠️ Side Effects: What to Actually Expect

Let's talk about side effects honestly.

Both medications share common stimulant side effects:

• Appetite suppression (very common, especially at first)
• Insomnia (if taken too late or dose too high)
• Increased heart rate (usually mild, 5-10 bpm)
• Slight blood pressure increase (typically 2-5 mmHg)
• Dry mouth
• Headaches (often related to dehydration)
• Irritability during comedown
• Anxiety or jitteriness (especially when starting)

Side Effect Differences

Based on clinical experience and patient reports:

Managing Side Effects

The good news is that most side effects are manageable:

• Appetite: Eat protein-rich breakfast before medication kicks in. Focus on calorie-dense snacks when hungry (nuts, smoothies, protein bars).
• Sleep: Take medication at the same time each morning. Avoid doses after 2 PM. Consider magnesium supplement at bedtime.
• Anxiety: Start with lower doses and titrate up slowly. Add therapy or anxiety medication if needed.
• Crash: Time your dose carefully. Eat regularly. Consider "booster" dose in afternoon (for Adderall IR).
• Dry mouth: Drink more water throughout the day. Sugar-free gum or lozenges help.

💰 Cost and Insurance: The Practical Reality

This is where the rubber meets the road.

Vyvanse Pricing

• Brand name only: No generic available until 2023, and generic supply has been limited
• Typical cost without insurance: $350-400/month
• With insurance: $30-70 copay (but many plans require prior authorization)
• Generic lisdexamfetamine: $75-150/month (when available)

Adderall Pricing

• Generic widely available: Both IR and XR versions
• Typical cost without insurance: $30-80/month (generic)
• With insurance: $10-30 copay
• Brand name: $200-350/month (rarely prescribed)

Insurance Coverage

Here's what I see in practice:

• Adderall generic is almost always covered as first-line treatment
• Vyvanse typically requires "step therapy" – you must try Adderall first
• Prior authorization for Vyvanse usually requires documentation that Adderall was ineffective or caused intolerable side effects
• Some plans won't cover Vyvanse at all, or place it in highest-cost tier

🎯 Who Should Take What? Clinical Decision-Making

So how do I actually decide which medication to prescribe?

Here are the factors I consider:

Vyvanse May Be Better If You:

• Need all-day coverage (long work/school days, evening responsibilities)
• Experience harsh crashes or rebound ADHD symptoms
• Struggle with anxiety or jitteriness on other stimulants
• Have a history of substance use (lower abuse potential)
• Prefer once-daily dosing with stable effects
• Have binge eating disorder (FDA-approved for this too)
• Are sensitive to "peak and valley" effects
• Have good insurance coverage that covers Vyvanse

Adderall May Be Better If You:

• Need flexibility in dosing (can adjust IR doses throughout day)
• Require faster onset (need to focus quickly in morning)
• Have shorter days or variable schedule
• Experience emotional blunting on Vyvanse
• Want ability to skip doses easily (shorter duration makes this easier)
• Have trouble falling asleep (can time doses to wear off by bedtime)
• Don't have insurance or need lower-cost option
• Tried Vyvanse and it didn't work well

Real Patient Examples

🔄 Can You Switch Between Them?

Yes, absolutely.

Switching between Vyvanse and Adderall is common and safe when done properly.

Dose Conversion Guidelines

These medications aren't exactly equivalent, but here are general conversion ratios:

• Vyvanse 30mg ≈ Adderall XR 10-15mg
• Vyvanse 50mg ≈ Adderall XR 20mg
• Vyvanse 70mg ≈ Adderall XR 25-30mg

These are starting estimates only. Your optimal dose depends on your individual metabolism and response.

How to Switch Safely

1. Don't stop cold turkey (though physical withdrawal is rare, sudden change can feel abrupt)
2. Plan the switch on a non-critical day (weekend or day off)
3. Start with equivalent or slightly lower dose of new medication
4. Give it at least 3-5 days before making dose adjustments
5. Keep notes on how you feel throughout the day
6. Follow up with your doctor within 2-4 weeks to assess response

❓ Frequently Asked Questions

Can I take both Vyvanse and Adderall?

Yes, this is actually a common strategy. I sometimes prescribe Vyvanse as the long-acting base with a low-dose Adderall IR "booster" in the early morning or late afternoon if needed.

This gives you the smooth, all-day coverage of Vyvanse with the flexibility and faster onset of Adderall.

Which one is less addictive?

Vyvanse has lower abuse potential because:

• It can't be crushed and snorted for rapid high
• The prodrug design creates gradual onset (less euphoria)
• It's classified as Schedule II, same as Adderall, but DEA notes lower diversion rates

That said, both can be misused. If you have a history of substance use disorder, discuss this openly with your doctor.

Do they cause the same weight loss?

Both suppress appetite significantly, especially in the first few months. Weight loss of 5-10 pounds is common when starting either medication.

Vyvanse may cause slightly more appetite suppression due to its longer duration. It's also FDA-approved for binge eating disorder, which reflects its strong effect on appetite.

Will switching medications reset my tolerance?

Not significantly. Since both are amphetamine-based, cross-tolerance exists. If Adderall has stopped working as well, switching to Vyvanse might help due to different metabolism, but don't expect it to feel like starting fresh.

If tolerance is the issue, talk to your doctor about:

• Taking periodic "drug holidays"
• Optimizing your sleep and diet
• Ruling out other causes (depression, poor sleep, life stress)
• Trying non-stimulant alternatives

Which is better for adults vs. children?

Both are approved for ages 6 and up. The choice depends on the same factors regardless of age:

• Children: Often prefer Vyvanse due to once-daily dosing (easier for school, no stigma of visiting nurse for second dose)
• Teens: Vyvanse may be preferred due to lower abuse/diversion risk
• Adults: Choice depends on schedule, insurance, side effect profile

Can I drink alcohol on these medications?

You can, but be careful. Stimulants can mask the sedating effects of alcohol, leading you to drink more than intended. This increases risk of:

• Alcohol poisoning
• Risky behavior
• Cardiovascular strain
• Dehydration

If you choose to drink, do so moderately and stay well-hydrated.

🔬 What Does the Research Say?

Let me break down the key studies:

Efficacy Studies

• Biederman et al. (2007): Vyvanse showed significant improvement in ADHD symptoms in adults at doses of 30-70mg, with effect sizes comparable to other long-acting stimulants
• Faraone et al. (2013): Meta-analysis found no significant efficacy differences between long-acting amphetamine formulations (Vyvanse, Adderall XR) when properly dosed
• Adler et al. (2008): Both medications showed similar improvements on objective attention tests and subjective symptom ratings

Duration and Pharmacokinetics

• Ermer et al. (2010): Vyvanse demonstrated smooth, consistent plasma levels for 10-14 hours, while Adderall XR showed dual-peak pattern
• Biederman et al. (2012): Patients reported Vyvanse effects lasting significantly longer into evening hours compared to other stimulants

Abuse Potential

• Jasinski & Krishnan (2009): Intranasal Vyvanse showed significantly lower "drug liking" scores compared to intranasal dextroamphetamine
• DEA diversion data: Vyvanse shows lower rates of diversion and illicit use compared to Adderall, though both are Schedule II

🎓 The Bottom Line: How to Choose

Here's my clinical algorithm:

1. Start with what insurance covers. If both are covered, consider other factors. If only one is covered, start there.
2. Consider your daily schedule: - Long, consistent days → Vyvanse - Variable schedule or shorter days → Adderall
3. Think about your side effect sensitivities: - Anxiety-prone or sensitive to "rushes" → Vyvanse - Trouble sleeping or emotionally blunted → Adderall
4. Try it for at least 2-3 weeks before deciding it doesn't work. Titrate the dose properly.
5. If first choice doesn't work, try the other. Many patients who don't respond to one respond beautifully to the other.
6. Consider combination strategies if single medication doesn't provide ideal coverage.

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