Concerta vs. Ritalin

Ritalin and Concerta are both stimulants that are commonly prescribed to help people manage the effects of attention deficit and hyperactivity disorder (ADHD). Both have methylphenidate as their active ingredient, but they are very different when it comes to how they work in the body, how long they are effective in the system, potential side effects, and how they can impact day-to-day living. 

Ritalin is an immediate-release medication that is often taken three times a day with each dose lasting for up to four hours.[1] Side effects that are commonly reported include difficulty sleeping, lesser appetite, and faster heart rate.

Comparatively, Concerta is an extended-release medication, which means that you need only take it once to get a gradual release of medication for up to 12 hours.[2] Concerta side effects are often similar to Ritalin’s side effects but not experienced as intensely due to the slow-release nature of the medication’s action. 

For many, the choice between the two will come down to preference and the ability or desire to take multiple doses of medication throughout the day. 

Ritalin vs. Concerta: Understanding Key Differences

This chart shows how Ritalin and Concerta compare at a glance:[2,3]

One of the biggest concerns for people making the choice between Concerta and Ritalin is how either medication will impact their day-to-day life. For many, Ritalin is the go-to choice because it has a long history of proven efficacy. However, because it is the shorter acting version, it may come with more severe side effects that make it difficult to work or go to school. 

Additionally, the multiple doses of Ritalin needed can be difficult to manage for kids at school who have to disrupt their daily schedule in order to go to the school nurse and get their medication every day. Concerta is often the preferred medication due to the lesser intensity of side effects and the fact that only one dose is required per day due to its extended-release formulation.

What Are the Risks of Concerta vs Ritalin?

Because Concerta and Ritalin both contain the active ingredient methylphenidate, they both share similar potential risks and concerns for users.

Both medications come with a risk of cardiovascular issues. For example, the stimulant nature of the drug may increase heart rate and raise blood pressure, which can be of special concern for people who have a pre-existing or undiagnosed cardiovascular condition. 

Gastrointestinal issues may also be a concern for users of Concerta and Ritalin, but primarily for Concerta users due to how the drug must be broken down over time in the gastrointestinal system. For example, those who have narrow intestines or other anatomical or functional abnormalities may find it difficult to process the outer shell of the Concerta pill and find the drug either is ineffective or causes them digestive distress. 

Strategies for Managing Risk of Abuse of Concerta & Ritalin

Methylphenidate is a stimulant substance, which means it comes with a potential for abuse. In people who are living with attention deficit and hyperactivity disorder, stimulants have the reverse effect that it does in the general population and calms the person down. In those who are not living with ADHD, the stimulant has a stimulating effect, creating a high in users that can be addictive. 

In order to prevent abuse of the medication, it is recommended that you take the following steps:

• Take the medication as prescribed. Do not crush pills, take more than prescribed, or take the medication if it is not prescribed to you.

• Keep medications under lock and key. In order to protect children and those who may be prone to substance abuse, keep the medications out of reach and in the hands of a responsible adult. 

• Continue to check in with your doctor. Body chemistry changes over time, especially for children as they grow into adulthood. A medication that was once necessary may not be needed forever. Appropriate dosing levels may change as well.

• Connect with a support system. In order to maintain an objective frame of reference for use of the drug, keep educated and supportive people around you who can help you answer questions and maintain boundaries. 

• Keep communication lines open. Whether you are the person taking the medication or you are helping someone you love to manage their medication, make sure that communication stays open and honest at all times.

Dosing Differences

The primary difference between Concerta and Ritalin is how they should be taken (such as how much should be taken per dose and the dosing schedule) and what options are available to patients.[3,4] 

Which Is Better to Treat ADHD?

There is little research comparing the efficacy of shorter-acting Ritalin to the efficacy of longer-acting Concerta, though there are a number of studies that look at how well methylphenidate in any form works to manage symptoms of ADHD compared to other ADHD drugs. 

Children & Adolescents 

For children enrolled in traditional school, it is clear that Concerta is by far the more efficacious choice.[5] The morning dose lasts throughout the day with a steady and controlled release of methylphenidate. This allows children to navigate the school day as well as after-school care without having to take another dose. 

However, that same study found that not all parents like to use medication on the weekends or vacations, preferring behavioral therapies instead. Additionally, not all children wanted or needed medication in the afternoon and evening after school. The insomnia side effect could make it harder for kids to fall asleep at night when they need to be well rested the next day.[5] 

Adults

Adults are able to manage their own medication, so the choice between Ritalin and Concerta will be based on whether or not they need the medication in the evenings and if they can tolerate what may be more significant side effects that come with shorter-acting Ritalin. 

When compared to other drugs commonly prescribed for the treatment of ADHD, one study found that in adults, methylphenidate came in second out of four different medications when it came to efficacy. All four medications worked better for symptom management than placebo, with a fifth helping less than placebo.[6]

In another study that compared the efficacy of different long-acting methylphenidate formulations for the treatment of ADHD across a range of studies, no one formulation stood out above the rest.[7] However, the study did note that switching between long-acting formulations was often recommended. It was also beneficial to swap a long-acting formulation for a short-acting one for a period of time.[7] 

It’s important to note that there are significant risks associated with long-term use of methylphenidate in adults. Even though one study found that Ritalin and Concerta were effective in treating ADHD in adults as long as the dose was high enough, another review of studies that looked into long-term impact of methylphenidate found that there were some statistically significant heart health risks, sleep disruption, and adverse psychiatric events to consider.[8,9]

Making an Informed Choice for You 

Ultimately, no matter how old you are, the choice between short-acting and long-acting methylphenidate formulations will best be determined with the support of a medical professional who considers your unique needs and preferences. 

Some things to consider include the following:

Medical History 

If you have a history of certain conditions, a particular medication might make more sense.

Cardiovascular Conditions

If you have a personal or family history of cardiovascular issues, taking methylphenidate in any form may not be the best choice, as the drug can raise heart rate and increase blood pressure. 

Gastrointestinal Issues 

If you are diagnosed with any issue that may negatively impact how the medication is digested and absorbed, some medications may not be a good fit, especially long-acting medications like Concerta. 

Problems With Kidney or Liver Function

In most cases, methylphenidate in the form of Ritalin or Concerta will not have a negative impact on either liver or kidney function. However, if you are living with a liver or kidney disorder, if the drug is abused (such as used intravenously), or if the medication is combined with use other illicit substances, it can be damaging.[10] 

Substance Abuse History 

For those who are living with ADHD, methylphenidate has a calming effect but for the rest of the population, it is a substance that can trigger high energy, a high, and addiction. For people who have a history of substance abuse, taking a medication like this can be a problem. It can lead to a relapse in recovery or the development of an addiction disorder. 

Day-to-Day Schedule 

The ability to take a medication multiple times a day can be a huge factor in determining whether Concerta or Ritalin is a better choice. Most people will need to take Ritalin a minimum of two times per day (once in the morning and then again around lunch when the first dose begins to wear off) in order to make it through the school or work day.

For kids at school, this can be difficult. Depending on the job, this can be a hardship for adults as well. Additionally, the nature of ADHD can make it difficult to manage a multi-dose medication regimen throughout the day, making it easier to take the longer-acting version, Concerta. 

Personal Experience With ADHD

ADHD is a spectrum disorder, which means that everyone diagnosed may experience different symptoms with a range of severity. For some, this means that a long-acting version will be more appropriate, especially if they experience significant issues all day long. For others, if symptoms are milder, it may be preferable to be off the medication when the activities of the day do not require support. 

Additionally, for those who are in the process of figuring out what works best for them in terms of dosing, Ritalin may be the better choice because it allows for more flexibility in adjusting doses as needed. 

Some people simply do not respond well to certain medications. They may experience side effects or see no change in symptom management. If they are living with a co-occurring condition that impacts how their body responds to medication or how they experience ADHD, this can be a factor as well. 

Patient Preference

Ultimately, the goal of treatment for any disorder is to improve quality of life. For many patients, the choice in medication comes down to what makes their life easier. This can mean determining if side effects are worth the benefits of a medication, if inconvenient dosing is worth the ability to be off the medication for a few hours a day, and how they feel on either version of the drug. 

Cost

The cost of medication can be a factor as well, especially if you don’t have insurance or have high co-pays for medication. There are generic options of both Ritalin and Concerta that can help to bring down costs if this is a factor. Depending on the details of your healthcare plan, either Ritalin or Concerta may be more expensive than the other. 

Work With a Medical Professional

It’s a good idea to work with the prescribing physician as well as a therapist while learning how to manage ADHD symptoms. Behavioral therapies can be an effective option in treatment, and most patients do best when they come combine them with the use of medication rather than choosing medication alone.[11]

Checking in regularly with both of these professionals can ensure that you are consistently making choices that are in the best interest of your health and your quality of life.