ADHD meds - Ritalin vs Elvance PLEASE HELP!

[ColdButteredToast]

I've recently been privately diagnosed with ADHD (more on the inattentive side if that makes a difference). I had a medication consultation a few days ago but obviously I didn't prepare and so couldn't make a decision, so the Dr had given me a 5 mins appointment this evening to tell her which I would like to titrate on.

Options are Ritalin (fast release) or Elvance (slow release). I can't remember why these were the only options but it seems they are. She said the advantage of the Elvance is that it can help with mood swings, and the advantage of the Ritalin is that you can titrate with smaller doses. Ritalin is also much cheaper but I've spoken to my GP and they will do a shared care agreement so I won't have to pay for my own meds long term.

She said that with either medication I can't drink alcohol 😭 I do like a glass of wine, so I'm planning to take them during the week only, and not on the weekends... Would the fast release be better for this maybe?

I'd be really grateful to hear others experiences/knowledge. I'm obviously reading the info pack she sent me too.

Thanks!!

Slow release is much better, much smoother overall if that makes sense.

methylphenadate has a pretty short half life. It’s not like antidepressants which need to build up in your system. You take it, it works then it’s fine so drinking after it’s worn off shouldn’t be too much of an issue but I suspect that once you get to the right dose you actually won’t want to drink very much anyway.

im still waiting for titration so do let us know how you get on.

Thanks @LoveSandbanks Is elvance methylphenadate then? Yes, will definitely update once I've tried whichever one for a while

Elvanse is lisdexamfetamine.
Ritalin is methylphenidate.

Elvanse has around 12/14 hours effect, so if you want to cover your working day I personally think this is the better option. Ritalin is very quick release so depending on what your aim with medication is, you could end up needing to take it frequently and would experience more peaks and troughs.
Either is fine to use on weekdays only, if that’s a concern.
DS takes Equasym, which is prolonged release methylphenidate. It lasts about 8 hours so fine for primary school. As he gets older I was advised he might switch to Elvanse as the longer time is needed. He is combined type ADHD so might not be relevant for your situation.

Both can be titrated but obviously Elvanse will only be once daily. The lowest dose I’ve seen is 20mg but it goes up to 70mg (I’m a pharmacist). I’ve seen all sorts of combinations and also with immediate release dexamfetamine prescribed if the patient wanted to top up later in the day with the Elvanse. It can be tricky getting it balanced but certainly for my ds, completely worth it.

Good luck, let me know if you have specific questions that I can try to help with.

Thanks @SleepEatSnoozeRepeat that's really helpful. Great to have a a pharmacist's view.

It would be great to know which you thought was less likely to cause heart/circulation problem down the line (both my parents have heart issues, and my mum has had strokes. I was given an ECG which is apparently fine, but obviously it's still concerning).

Also re the alcohol, how long would you say was needed between a dose of Elvance and a glass of wine? 😬

Thanks again!

No idea why half of that was bold... 🤷🏼‍♀️

Afraid everyone responds differently - my DD has worked her way through fast release Ritalin, Adderol and a host of other meds atomoxetine etc) where the side effects have been significant. Finally trying slow release Ritalin from next week on the basis that the fast release actually had an impact on focus but affected her appetite badly. I'm adhd and find the fast release really effective as can take them on an as and when basis.

In the end, they will each work, but you need to try them for a good 4weeks to see if they 'suit' you and be open to trying a few before finding the best fit and dosage. We're over a year in and a bit disappointed that it wasn't an instant fix.

That's not what I want to hear @CautiousLurker I need an instant fix!! 😂

Seriously, thank you - it's good to get a reality check. I hope the slow release ritalin works for your daughter 🤞🏼

As @CautiousLurker says, it’s very individual. In the case of ds, it really was like a switch was flicked from the first dose. It was astonishing, I didn’t expect it and had prepared myself for it not to help but it truly changed his life. He titrated up over 3 months and is now stable with minimal side effects, although as he grows I know it will need to change again. So you never know, but probably best to expect nothing and then be happy if it works out!

Regarding use with alcohol, my understanding is that it can amplify side effects and also alcohol effects. Everyone is different so it might be an issue, it might not. Heart rate increase and flushed skin are more common, potentially you could get very drunk very quickly on not a lot! During titration you are best to avoid alcohol completely as this is when you are monitoring and looking for side effects. The body does often become tolerant to some of these (reduced appetite is the most common thing, but it can level off so it’s not an issue with time). So someone well established on a dose could probably have one drink in the evening (12 hours or more after a dose) and be fine. If you know there’s an event coming up it would be better to miss the medication on that day.

I can’t find much information on long term use, I think it’s probably still quite early to tell what effect therapeutic doses will have on the CV system over time. Other than to monitor blood pressure and side effects, and contact your consultant if there’s a change, I don’t know that there’s much else to do.
When we made the decision about ds I thought long and hard about the possible issues and it was actually dh who said, look at what he will go through without trying this. Ds was already so stressed out, anxiety and self esteem issues, unable to engage with education etc. We felt the benefits outweighed the risks. Only you can see how this all fits into your own life. I know I felt we owed it to ds to try it and see.

I’d go with Elvamse. Theres a shortage of slow release methylphenidate at the moment.

My dd was doing amazing in Xenidate which is now unavailable. Shes been switched to Elvanse. The jury’s out on it at the moment.

Buy it is designed for adults as the window of release is much longer.

But l agree that when it works it’s like a switch being tripped. But it doesn’t work straight away as you have to titrate

Thanks all. I went with Elvance. Will report back!

@ArseInTheCoOpWindow
Is it easier to get elvanse ?
We are really struggling with slow release methylphenidate and stock issues. It's such a shame as DD is just settling after starting in March.
36mg and 18mg are virtually impossible to get. I am told modified release 10 and 20 mg are available but am not sure if they release over 12 hours which is what we want.
DD gets the awful meds crash and is in 6th form so we really need a long and slow release

If you look on the Boots stock checker it’s flooded with Elvansr.

Honestly this makes me so angry, Dd was just stabilised and now we’ve got to swap over. I’m sick of there being so many shortages. Every month l phone 10 pharmacies.

Currently the stock issues are with the 18mg/27mg/36mg/54mg methylphenidate 12 hour release forms, yes. Brand names include concerta, xenidate, delmosart, xaggitin. Elvanse was a problem at all strengths for about a year but that has improved recently. The 8 hour release forms of methylphenidate have been ok most of the time, these include equasym and medikinet. Instant release has also been ok.

It has been completely infuriating for pharmacies and patients alike. I don't know what to suggest other than to ask for generic prescriptions to be written so any appropriate brand can be supplied as they seem to vary with what is available day to day.

It honestly feels like yet another stick to beat Sen patients with. First the effort to get referred, then diagnosed, then titrated, then just getting the meds at all. Had we not gone private ds would still not have been seen here, he was referred in march 2021. It's awful.