Focalin XR vs Adderall XR: understanding these ADHD medications

Is your ADHD medication not working well? Or maybe you’re forgetting to take your second dose of a standard-release drug? An extended-release medication may be the answer. Focalin and Adderall are popular options, but how do Focalin XR vs Adderall XR compare?  

In this article, we tell you so you can navigate the similarities and differences between these 2  extended-release medications. That way, you can have an informed discussion with your healthcare provider and get the right medication to relieve your ADHD symptoms.

Need a provider? On Klarity Health, find and see an online ADHD provider in as little as 24 hours to discuss your symptoms and determine if ADHD medication like Focalin XR or Adderall XR is right for you.*

Focalin XR vs Adderall XR — is one better?

While these 2 central nervous system (CNS) stimulant medications for ADHD are popular, they haven’t been directly compared in adults. And a head-to-head comparison study in children and adolescents found no difference in ADHD symptoms between Focalin XR (methylphenidate) and Adderall XR (amphetamine/dextroamphetamine). Yet, 43% of participants responded better to 1 medication than the other. The study concluded that dose level has more effect on the response to ADHD medication than the type of stimulant used. 

Because there isn’t a direct comparison of these medications in adults with ADHD, let’s turn to real user experiences to find out more. 

Real user experiences

Real people who’ve switched between Adderall XR (or Adderall) and Focalin XR (or Focalin) share their experiences on Reddit and in reviews on websites like drugs.com, WebMD, and GoodRx. Some Reddit highlights include:

“Having taken both types of meds myself, I would say that the Adderall [XR] feels smoother throughout the course of the day and has more of an ‘awakening’ effect, but that the methylphenidate has a superior effect (at least for me) on learning and working memory” — FeralCatalyst

“I take [Focalin] for ADHD and I’m a fan. I felt big energy swings with Adderall, but it’s been a lot smoother with Focalin” — jenofindy

“I started Focalin and found it to be most helpful with my symptoms, but it negatively affected my blood pressure. I’ve switched to Adderall, and I’ve found that it’s less effective for my ADHD symptoms and also leaves me in a constant low-level state of agitation where I [lose] my patience much more quickly than normal” — tombosauce

And Alternative-Claim 584 says, “I’m a prescriber and prefer ordering Focalin over Adderall 9 out of 10 times. It works in a way that is theoretically kinder to the brain, especially over the long term. Fewer side effects for most people as well”.

What is Focalin XR?

Focalin XR (dexmethylphenidate) is an extended-release medication used to treat ADHD in children ages 6 to 12, adolescents, and adults. Its immediate-release form, Focalin, was US Food and Drug Administration (FDA)-approved first, in 2001. Focalin XR followed in 2005. 

It’s a popular first-time stimulant for people with ADHD, according to Dr. David Danish at Philadelphia Integrative Psychiatry. Almost 5 million prescriptions (Focalin and Focalin XR) were dispensed in 2022 alone, comprising 6.2% of stimulant prescriptions for ADHD dispensed that year. And, at the time of publication, it has a 6.8 out of 10 rating on drugs.com with 62% of users reporting a positive experience.

Focalin XR is a stimulant that blocks the reuptake of norepinephrine and dopamine in the brain. Norepinephrine and dopamine are neurotransmitters that help control hyperactivity, impulsivity, and focus. Focalin XR increases their availability in the brain. Focalin works the same way, though it’s taken more often because it doesn’t last as long in your body.

Forms and dosages of Focalin XR

Focalin XR capsules come in 5-, 10-, 15-, 20-, 25-, 30-, 35-, and 40-milligram dosages. Extended-release medication normally lasts in your system for up to 12 hours. 

The recommended starting dose for adults is 10 milligrams. Your provider will increase your dose by 10 milligrams each week until you reach your maintenance dose or the maximum recommended dose of 40 milligrams.

If you take Focalin XR, take it first thing in the morning with or without food. For best results, take it at the same time every day and not after 12 p.m. (noon). You can swallow the capsules whole or break them up and sprinkle the contents onto food.

What Focalin XR costs

You can get brand-name or generic Focalin XR. The brand name retails for $527.33 for a 1-month supply of 5-milligram capsules, according to drugs.com with their discount card. Depending on the dose, you could pay up to $605.34 for a 1 month supply (35- and 40-milligram doses). 

You can save on Focalin XR if you have health insurance that covers it or with online coupons. Offers from websites like GoodRx, SingleCareRx, Optum Perks, and drugs.com can knock the price down 3 to 80%. Contact your insurance provider for more information on pricing under your plan.

Focalin XR side effects

Common side effects of Focalin XR include dry mouth, indigestion, headache, anxiety, and a sore throat.

Less common, but more severe side effects of Focalin XR include heart problems, psychosis, circulation problems in fingers and toes, and prolonged and painful erections.

Drug interactions for Focalin XR

Focalin XR has 4 known drug interactions. It isn’t recommended to take Focalin XR alongside monoamine oxidase inhibitors (MAOIs), antihypertensive (high blood pressure) drugs, halogenated anesthetics, or risperidone. 

Tell your healthcare provider if you take these types of medications before starting Focalin XR. And, if you take Focalin XR and need surgery, be sure your anesthesiologist is aware of your medications.

Warnings to know about if taking Focalin XR

Focalin XR comes with some contraindications, warnings, and precautions. For example, it isn’t recommended if you’re sensitive to any of its ingredients or methylphenidate. Adverse reactions have also been reported with Focalin XR use. Talk to your healthcare provider if you’re concerned about any of the following warnings.

Potential for abuse, misuse, and addiction

Focalin XR is a Schedule II controlled substance, meaning it has a high risk for dependency and abuse. To avoid this, take your medication as prescribed. Misuse of Focalin XR can increase the risk of addiction. If you need to stop taking it, contact your healthcare provider. They will help you do so safely to reduce the risk of withdrawal symptoms.

Risk to patients with serious cardiac disease or heart problems

Focalin XR can increase blood pressure and heart rate. If you take it, your provider will monitor your blood pressure and heart rate, regardless of your initial heart health. You shouldn’t take Focalin XR if you have known heart defects, cardiomyopathy, serious arrhythmias (irregular heartbeat), coronary artery disease, or another serious cardiac disease. 

Risk for new or worsening psychiatric problems

Taking Focalin XR can increase the risk of new or worsening psychiatric problems, such as psychosis or mania. Take it with caution if you have a history of psychosis or bipolar disorder.

Long-term suppression of growth in children

Central nervous system (CNS) stimulants, like Focalin and Focalin XR, can cause weight loss and slowed growth in pediatric patients. If your child takes Focalin XR, their provider should closely monitor their growth.

Increased risk for glaucoma

There have been reports of increased intraocular (inner-eye) pressure, glaucoma, and acute angle closure glaucoma in people taking Focalin XR. If you have glaucoma, or are at risk for it, you should only take Focalin XR if the benefits outweigh the risks. Talk to your provider about whether Focalin XR or another medication is best for your situation. 

Risk of developing motor or verbal tics and worsening Tourette’s syndrome

CNS stimulants, including Focalin XR, can cause motor and verbal tics. They can also worsen your symptoms if you have existing tics or Tourette’s syndrome. Your provider should assess your personal and family medical history before prescribing Focalin XR and monitor your symptoms throughout treatment.

What is Adderall XR?

Adderall XR is the extended-release version of Adderall, which also comes in a standard-release formula. Originally approved as an anorectic (appetite-suppressant) in 1960, Adderall was approved to treat ADHD in 1996. Adderall XR was approved in 2002. 

While Focalin XR may be a popular first-time stimulant for ADHD, prescriptions for Adderall (and Adderall XR) far exceed Focalin/Focalin XR. Over 44 million Adderall prescriptions were written in 2022, including Adderall XR. That’s 56% of the stimulant prescriptions for ADHD dispensed that year. At the time of publication, drugs.com rates Adderall XR at 7.9 out of 10, with 75% of reviewers reporting a positive experience.

The active medications in Adderall XR are amphetamine and dextroamphetamine. These 2 CNS stimulants work together to increase the amount of dopamine and norepinephrine in the brain, which helps relieve symptoms of ADHD, including hyperactivity, impulsivity, and inattention. 

Immediate-release Adderall works the same way, except it doesn’t stay in your system as long and has to be taken twice a day instead of once a day.

Forms and dosages of Adderall XR

Adderall XR comes in 5-, 10-, 15-, 20-, 25-, and 30-milligram extended-release capsules. Generic Adderall XR also comes in  37.5- and 50-milligram doses. 

The extended-release formulation keeps medication in the body for up to 12 hours.  You take it first thing in the morning, with or without food, so its effects last most of the day and taper off toward evening.

Adults normally start with 20 milligrams once a day. Clinical studies of doses up to 60 milligrams per day suggest that doses above 20 milligrams don’t offer additional benefits.

What Adderall XR costs

All strengths of Adderall XR retail for $759.54 for a 1-month supply, according to drugs.com with their discount card. The generic version retails for around $53 per month. 

You’ll likely pay less if you have health insurance. Contact your insurance company for pricing details specific to your plan.

You can also save on Adderall XR with coupons from websites like GoodRx, Optum Perks, SingleCareRx, and drugs.com. Print or download coupons for 3 to 80% off your Adderall prescription at participating pharmacies.

Side effects of Adderall XR

Common side effects of Adderall XR include dry mouth, low appetite, anxiety, trouble sleeping, headaches, weight loss, nausea, dizziness, diarrhea, fast heartbeat, agitation, weakness, and urinary tract infections (UTIs).

Less common, but more severe side effects of Adderall XR include seizures, circulation problems, hallucinations, muscle twitching, loss of coordination, confusion, changes in blood pressure, sweating or fever, nausea, vomiting or diarrhea, muscle stiffness or tightness, high body temperature, and serotonin syndrome.

Drug interactions for Adderall XR

Adderall XR has 7 known drug interactions. You shouldn’t take it if you also take MAOIs, drugs that increase serotonin (serotonergic drugs), including CYP2D6 inhibitors, alkalinizing or acidyifying agents (like sodium bicarbonate or citric acid), tricyclic antidepressants, or proton pump inhibitors (PPIs). 

Warnings for Adderall XR

Adderall XR comes with many of the same warnings as Focalin XR and some additional ones. It isn’t recommended if you have an allergy to any of its ingredients or are hypersensitive to amphetamine. 

Reach out to your healthcare provider if you’re concerned about the following warnings for Adderall XR use.

Dependency warning for Adderall XR

Adderall XR is a Schedule II controlled substance, meaning there’s a high risk for dependency and abuse. It should only be used as prescribed by your healthcare provider. Suddenly stopping this medication may cause withdrawal symptoms. If you need to stop taking Adderall XR, talk with your provider first.

Risks to patients with heart problems or serious cardiovascular disease

Like Focalin XR, Adderall XR can increase heart rate and blood pressure. Your provider will monitor your heart health while you take Adderall. You shouldn’t take Adderall XR if you have heart defects, cardiomyopathy, irregular heart rate (arrhythmia), coronary artery disease, or other serious cardiac conditions.

Risk for new or worsening psychiatric problems

Adderall XR can cause new or worsening psychiatric problems, including symptoms like psychosis or mania. You should use Adderall XR with caution if you have a history of psychosis or bipolar disorder. 

Long-term suppression of growth in pediatric patients

CNS stimulants, like Adderall XR, have been known to cause weight loss and slowed growth in pediatric patients. If your child takes Adderall XR, closely monitor their growth and tell their provider about any concerns you have.

Potential for circulation problems, including Raynaud’s syndrome

CNS stimulants used to treat ADHD are associated with Raynaud’s syndrome, a disorder that can limit blood flow to the skin, and other circulation problems. Monitor the temperature and feeling in your fingers and toes while taking Adderall XR. Tell your provider about any changes.

New or worsening motor tics, including Tourette’s syndrome

Adderall XR is associated with worsening Tourette’s syndrome and the development of new motor or verbal tics. Share your family and personal medical and psychiatric history with your healthcare provider before taking Adderall XR or another CNS stimulant for ADHD.

Serotonin syndrome

Serotonin syndrome is potentially life-threatening and can happen when Adderall XR is used with other serotonin-increasing (serotonergic) drugs. These include MAOIs, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants, among others. 

Symptoms of serotonin syndrome include changes in mental status, fast heartbeat, dizziness, high blood pressure, high body temperature, flushed skin, tremors, incoordination, seizures, and gastrointestinal symptoms (nausea, vomiting, diarrhea). If you have these symptoms, contact your healthcare provider or 911 immediately.

Find an ADHD healthcare provider now and have an appointment in as little as 24 hours

Klarity Health is dedicated to helping you find fast, affordable, caring ADHD treatment. On the Klarity Health platform, find a licensed and certified ADHD specialist and have an appointment in as little as 24 hours.* Your provider can help you decide if Focalin XR, Adderall XR, or another ADHD medication is right for you.

Schedule an appointment with a licensed provider on Klarity Health today.