Strattera vs Concerta: what's the difference?

Finding the right ADHD medication requires patience, trial and error, and a little help. That’s why in this comparison article, you can find information to better understand how 2 commonly prescribed attention deficit hyperactivity disorder (ADHD) medications — Strattera vs Concerta — are similar and different and which may be best for you.

The licensed medical professionals on Klarity can help you find the right ADHD treatment for your symptoms and needs. To determine whether Concerta. Strattera, or another ADHD medication is right for you, find a provider on Klarity today.

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

Strattera vs Concerta: are they the same type of medication?

Concerta (methylphenidate hydrochloride extended-release) and Strattera (atomoxetine) are 2 different types of medications that both treat the symptoms of ADHD. Concerta is a central nervous system (CNS) stimulant, and Strattera is a non-stimulant selective norepinephrine reuptake inhibitor (SNRI). Stimulant and non-stimulant ADHD medications work differently. (Note the brand name Strattera was discontinued in November 2023. The generic atomoxetine is available.)

Both Concerta and Strattera work on chemicals — called neurotransmitters — which are naturally found in the brain. Concerta works on norepinephrine and dopamine, and Strattera works on norepinephrine and serotonin.

Chemically, they’re different drugs, but each works to elevate the amount of norepinephrine in your brain’s synapses. In"typical" brains, enough norepinephrine is available for the brain to function normally. However, in the brain of someone with ADHD, low levels of norepinephrine cause many of the common ADHD symptoms associated.

Hyperactive/impulsive symptoms of ADHD

• Inability to sit still 
• Inability to remain calm
• Talking non-stop, unable to be quiet
• Unable to wait in line or wait for their turn
• Engaging in risky or impulsive behavior; acting without thinking
• Interrupting conversations
• Moving or fidgeting constantly

Inattentive symptoms of ADHD

• Having a short attention span — being unable to concentrate on tasks 
• Becoming distracted easily and derailed from tasks at hand
• Making careless mistakes
• Losing items frequently
• Forgetting important dates, events, and appointments
• Difficulty sticking with tasks tedious and time-consuming tasks that require focus
• Difficulty carrying out instructions or remembering directions

What is Concerta?

Concerta (methylphenidate) is usually a first-line treatment for ADHD symptoms. The chemical that makes Concerta is called methylphenidate, which belongs to a family of CNS stimulants.

How does Concerta work?

For brain cells (called neurons) to communicate effectively, neurotransmitters must be present in the spaces between them (called synapses). Low levels of norepinephrine in the synapses are associated with many of the inattentive and hyperactive symptoms of ADHD.

Concerta elevates levels of norepinephrine and dopamine in the brain by blocking the receptors that normally reabsorb these neurotransmitters back into the brain cells. The blocking mechanism found in medications, like Concerta, treat ADHD symptoms by raising the number of neurotransmitters available for communication between brain cells.

It effectively helps your brain cells communicate better by ensuring enough chemical messengers are available. 

Forms and doses of Concerta

Concerta is available as tablets that have many different concentrations. This U.S. Food and Drug Administration (FDA)-approved medication comes in four extended-release tablet strengths available in 18, 27, 36, and 54 milligram dosage strengths for individuals between 6 to 65. 

You take your Concerta tablet by mouth. It’s recommended to take it during the mornings or as prescribed by your healthcare provider. You only need to take it once a day, because it is an extended-release tablet.

What Concerta is used to treat

Concerta is FDA-approved to improve ADHD symptoms in adults and children 6 and. older. It improves focus, attention, organization, and the ability to control impulsive behavior. Concerta is also used off-label (for a purpose it’s not FDA-approved for) to treat a sleeping disorder called narcolepsy. 

What does Concerta cost?

The price you pay for Concerta depends on your insurance, dose, and pharmacy. 

The average retail price for 100 brand-name Concerta tablets ranges from $1,367 to $1,572 depending on dose according to drugs.com.

Concerta side effects

It’s always important to know what you might expect when starting Concerta. Here is a list of potential side effects. 

Common side effects of Concerta include:

• Decreased appetite
• Headache
• Dry mouth
• Nausea
• Trouble sleeping
• Anxiety
• Dizziness
• Weight loss
• Irritability
• Increased sweating

Less common and serious side effects:

• Seizures
• Priapism (painful erection in males lasting more than 4 hours) 
• Circulation problems in fingers and toes (peripheral vasculopathy, including Raynaud’s phenomenon)
• Slowed growth in children 
• Eye problems (increased pressure in the eye and glaucoma
• New or worsening tics or worsening Tourette’s syndrome
• Eyesight changes or blurred vision
• Possible blockage of the intestine

Tell your healthcare provider immediately if any of these symptoms don’t subside or get worse. 

Warnings of Concerta misuse

Concerta is considered a Schedule II (CII) drug with a risk of misuse and addiction. Concerta isn’t suitable for individuals with a history of substance abuse or addiction and should consider taking a non-stimulant ADHD medication, like Strattera. 

Misuse of Concerta can lead to serious health consequences. Taking higher doses than prescribed, using the medication more frequently than recommended, or using someone else’s medication is considered misuse and can result in severe health problems. Physical dependence, heart-related issues, psychological disorders, and, in extreme cases, even death can occur as a result of misuse.

To ensure effective and safe ADHD treatment, it is crucial to follow the prescribed dosage and usage instructions provided by your healthcare professional. Regular communication with your provider about any side effects or concerns is essential to monitor your response to the medication and make any necessary adjustments to your treatment plan.

Patients with the following underlying conditions should use Concerta with caution:

• Allergy or hypersensitivity to methylphenidate HCI 
• Monoamine oxidase inhibitor (MAOI) use in the last 14 days 
• History of severe heart disease (structural abnormalities, arrhythmias, coronary heart disease, and cardiomyopathy). 
• Untreated glaucoma
• Tourette Syndrome and motor tics 
• Severe intestinal strictures (esophagus, stomach, or intestinal problems)
• Circulation problems (hypertension or hypotension or increased JVP) 

No adverse effects during pregnancy or breastfeeding are known, but healthcare providers advise only taking it if needed. 

Drug interactions for Concerta

Before starting Concerta, ensure all your medications are documented with your medical provider. We suggest having a list of all the medications to give your healthcare provider to avoid any potential for serious drug interactions. 

Concerta shouldn’t be taken with MAOIs, including the following medications: isocarboxazid, linezolid, methylene blue, phendimetrazine, phenelzine, safinamide, selegiline transdermal, tranylcypromine, and Yohimbe. When starting Concerta, be sure to stop using MAOIs for 14 days before taking your first dose. 

Patients are advised to limit alcohol intake. 

What is Strattera?

Strattera is the brand name for the active ingredient atomoxetine. Brand-name Strattera was discontinued in November 2023. The generic atomoxetine is available. It’s a selective norepinephrine reuptake inhibitor. Strattera is a non-stimulant medication used primarily to treat depression and is also prescribed to treat ADHD. It helps increase attention and ability to complete tasks by reducing distractions and stopping fidgeting. 

How does Strattera work?

SNRIs work by blocking norepinephrine and serotonin receptors in the brain’s neurons. Like Concerta, Strattera elevates levels of norepinephrine in the synapses between neurons. Unlike Concerta, Strattera doesn’t affect dopamine levels but increases serotonin.

Because atomoxetine isn’t a CNS stimulant, it’s an ideal alternative ADHD medication for people who can’t take stimulants for medical reasons. These medical reasons may include anxiety, cardiovascular disease, or substance abuse disorder. 

Forms and doses of generic Strattera, atomoxetine

Atomoxetine capsules come in dosages of 10, 18, 25, 40, 60, 80, and 100 milligrams. Your prescribed dosage varies depending on your age and body weight. 

Strattera capsules are taken by mouth. You’ll be prescribed to take a first dose in the morning and a second dose in the afternoon. 

What Strattera treats

Strattera (atomoxetine) is the first FDA-approved non-stimulant medication to improve the treatment of ADHD by increasing attention and decreasing impulsiveness and fidgeting. 

What does Strattera or atomoxetine cost?

Your cost for Strattera will vary depending on insurance, dosage, and pharmacy. 

The full retail price for atomoxetine runs from $106 to $140 depending on dosage for 30 capsules. If you take 2 a day, that means you pay $212 to $280 a month if you pay the full price.

Strattera and atomoxetine side effects

Common side effects of Strattera or atomoxetine in adults are:

• Constipation
  Dry mouth
  Nausea
  Decreased appetite
  Dizziness
  Sexual side effects
  Problems passing urine
• Weight Loss

Serious side effects in adults:

• Suicidal thoughts and actions
• Mental health problems
• Severe. liver damage
• Heart problems
• Serious allergic reactions
• Problems passing urine including
• Trouble starting or keeping a urine stream 
• Cannot fully empty the bladder

Strattera warnings

Strattera (atomoxetine) can increase suicidal ideations in children and adolescents. Patients who are started should be closely monitored for suicidality (suicidal thinking and behavior), unusual behavior changes, and clinical outcomes. The average risk of previously observed patients was 0.4% (5/1357 patients).

Drug interactions for Strattera

Tell your provider about any medication or supplement you currently take before starting Strattera or atomoxetine — especially medications for asthma, heart conditions, and depression since Strattera can reduce the metabolism of these medications. 

Don’t use Strattera if you took an MAOI within 14 days. Common MAOIs include isocarboxazid, phenelzine, selegiline, or tranylcypromine.

Serotonin syndrome

When taking medications that elevate serotonin levels in the brain, watch for symptoms of serotonin syndrome. Serotonin syndrome is a rare but potentially fatal condition that usually occurs within a few hours of taking medication that elevates serotonin levels. 

Symptoms of serotonin syndrome include:

• Loss of muscle coordination
• Confusion
• Rapid heart rate and high blood pressure
• Agitation or restlessness
• Twitching muscles
• High blood pressure
• Muscle rigidity
• Insomnia
• Dilated pupils

Seek medical attention immediately if you experience any of these symptoms in the first couple hours after taking a new SSRI, SNRI, or MAOI or increasing your dose. 

Strattera vs Concerta: which ADHD medication is right for you?

Both Strattera and Concerta are effective at treating symptoms of ADHD. However, they use different mechanisms to do this. 

• Concerta is an SNRI and works predominantly on norepinephrine and serotonin. 
• Strattera is a CNS stimulant that works on norepinephrine and dopamine. 

They each produce different side effects on the body, meaning that one might be more suitable for your medical needs. For example, if you are someone who cannot take stimulants because you have a history of heart disease, substance abuse, or are prone to anxiety, Strattera is a non-habit-forming, non-stimulant alternative to Concerta. 

Concerta might be a better option for you if you can tolerate stimulants. Determining which ADHD medication is best for you requires patience, a bit of trial-and-error, and guidance from an ADHD-trained healthcare provider.

Find a provider to prescribe Strattera or Concerta on Klarity

On Klarity, find providers who are licensed and experienced in prescribing ADHD medication and can help find the right ADHD medication for you. Find a provider and have an appointment in as little as 24 hours so you don’t wait to find the most effective ADHD treatment for your symptoms.

Schedule an appointment on Klarity today and determine whether Concerta or Strattera is right for you.

Sources
DailyMed, LABEL: CONCERTA- methylphenidate hydrochloride tablet, extended release, Oct. 2023, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a88218c-5b18-4220-8f56-526de1a276cd

DailyMed, LABEL: ATOMOXETINE- atomoxetine capsule, Mar. 2021, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f266ab7b-5a68-42b5-b204-e3249bea0aed