Compare ADHD medicines
Methylphenidate vs dexamfetamine: what changes?
Methylphenidate and dexamfetamine are different stimulant medicines. Either may help ADHD, but response varies. This comparison concerns dexamfetamine tablets, not Elvanse, which contains lisdexamfetamine and has a different daily pattern.
Written and clinically reviewed by Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
Last updated: Last reviewed: Next review:Key points
- They are different stimulant medicines, and response varies.
- Methylphenidate comes as short-acting and modified-release products; dexamfetamine tablets are short-acting.
- Adult use of Amfexa is off-label.
- There is no direct milligram conversion between them.
How do the medicines compare?
| Feature | Methylphenidate | Dexamfetamine tablets |
|---|---|---|
| Available patterns | Short-acting and modified-release products | Short-acting |
| Coverage | A few hours for IR; longer coverage depends on the MR brand | Several hours per dose |
| Schedule | Depends on the formulation | May require more than one prescribed dose |
| Adult use | NICE first-choice option; product licences vary | NICE-supported use in selected circumstances; Amfexa use in adults is off-label |
| Dose conversion | No direct milligram conversion to dexamfetamine | No direct milligram conversion to methylphenidate |
Sources: NICE guideline NG87: medication choice (recommendations 1.7.7 to 1.7.22); Amfexa (dexamfetamine): Summary of Product Characteristics.
Why might one help when the other does not?
The medicines affect dopamine and noradrenaline signalling in different ways. Your response to one does not reliably predict your response to the other.
Your prescriber should assess an adequate trial, including benefit in daily life and unwanted effects. A difficult first few days do not automatically establish that the medicine will never suit you.
When is dexamfetamine considered?
For children and young people aged 6 to 17, dexamfetamine is licensed when methylphenidate has not helped enough. NICE also lists it for those whose symptoms respond to lisdexamfetamine but who cannot tolerate its longer effect.
For adults, NICE particularly identifies people who respond to lisdexamfetamine but cannot tolerate its longer effect profile.
Off-label means the use is outside the product’s licence. It does not automatically mean the treatment is inappropriate, but your specialist should explain the reason and monitoring plan.
Sources: NICE guideline NG87: medication choice (recommendations 1.7.7 to 1.7.22); Amfexa (dexamfetamine): Summary of Product Characteristics.
What should I compare during treatment?
Record when you can start tasks, sustain attention and manage impulsive behaviour. Include appetite, sleep, mood and any physical symptoms.
The goal is useful functioning with acceptable side effects. A noticeable “kick” is not a reliable measure of treatment quality.
Common questions
Does methylphenidate work better than dexamfetamine?
No medicine wins for everyone. Trials show both help many people with ADHD, and the response to one does not predict the response to the other. In the UK, methylphenidate is tried first in children and young people, and either methylphenidate or lisdexamfetamine first in adults. Dexamfetamine is usually considered after those.
Is dexamfetamine simply a stronger methylphenidate?
No. It is a different medicine. Comparing the milligram numbers does not show which is stronger or more suitable.
Is dexamfetamine the same as Elvanse?
Elvanse contains lisdexamfetamine, which your body converts into dexamfetamine. The products are taken differently and have different dosing instructions.
Can I swap between them using a conversion chart?
Do not do this yourself. Your prescriber must select the new medicine, dose and switching schedule.
Sources
- NICE guideline NG87: medication choice (recommendations 1.7.7 to 1.7.22). NICE
- Amfexa (dexamfetamine): Summary of Product Characteristics. eMC
- Ritalin 10 mg tablets (immediate-release methylphenidate): Summary of Product Characteristics. eMC
- Ritalin XL: Summary of Product Characteristics. eMC
- Concerta XL: Summary of Product Characteristics. eMC
This page is written for educational purposes and does not constitute medical advice. Always follow the guidance of your prescriber or pharmacist. If you have concerns about your medication, contact your clinical team.
About this page
- Written and clinically reviewed by
- Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
- First published
- Last updated
- Last reviewed
- Next review
“Last updated” is when the content last changed. “Last reviewed” is when it was last checked against current sources.
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