Key Points

• Azstarys (serdexmethylphenidate and dexmethylphenidate) is a long-acting central nervous system (CNS) stimulant for the treatment of attention-deficit hyperactivity disorder (ADHD) in patients 6 years of age and older. It is usually taken once per day.
• Adderall (mixed amphetamine salts) is also a CNS stimulant for the treatment of ADHD, but is used in patients 3 years of age and older. Adderall is also approved to treat narcolepsy (sudden deep sleep attacks) in patients 6 years of age and older. It is usually taken 2 to 3 times per day.
• Adderall XR (mixed amphetamine salts XR) is a long-acting form given once per day for the treatment of ADHD in patients 6 years of age and older.
• Azstarys is not available as a generic option and is an expensive medicine, while more affordable generics are available for both Adderall and Adderall XR. The manufacturer may be able to offer financial assistance for Azstarys.

CNS stimulants adjust chemicals in the brain and nerves that contribute to symptoms of ADHD, such as hyperactivity and impulse control.

Azstarys (dexmethylphenidate and serdexmethylphenidate) contains serdexmethylphenidate, a prodrug of dexmethylphenidate, co-formulated with immediate-release dexmethylphenidate. This combination provides a fast onset (from immediate-release dexmethylphenidate) and a longer duration of action without the spikes in dexmethylphenidate concentrations. This can help with morning routines before school or work and then last throughout the day. In the evening, Azstarys gradually wears off.

Adderall contains a quick-acting (immediate-release) mixture of mixed amphetamine salts and may require multiple doses per day. Adderall XR is a longer-acting formulation of Adderall. It is released in the body more slowly and is dosed only once per day.

The immediate-release brand name Adderall has been discontinued in the U.S. but is still available as a generic option. However, the brand name of Adderall XR is still available on the market.

These products are Schedule II federally controlled substances due to the possibility of drug abuse or dependence. Keep the medicine in a safe place away from children and pets. Do not let others access these medicines improperly or use them without a prescription.

How do I take Azstarys or Adderall?

Take these medicines exactly as prescribed by your doctor. Do not change your dose or stop treatment unless approved by your doctor. Your doctor may adjust your doses if needed, or stop treatment for a while to check attention-deficit hyperactivity disorder (ADHD) symptoms.

Azstarys

Azstarys capsules are taken once daily with or without food. The capsules can be opened and sprinkled on 2 tablespoons of applesauce or dissolved into 50 mL of water if the child has trouble swallowing the capsules. All of the applesauce or water mixture should be swallowed within 10 minutes.

Azstarys (serdexmethylphenidate / dexmethylphenidate) capsules come in 3 strengths: 26.1 mg / 5.2 mg, 39.2 mg / 7.8 mg and 52.3 mg / 10.4 mg. Do not substitute Azstarys for other methylphenidate products due to the potential for dosing errors.

Adderall / Adderall XR

Adderall comes as an oral tablet in 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg strengths. Adderall is usually dosed 2 to 3 times per day. The first daily dose is given in the morning followed by doses 4 to 6 hours apart. Initially, doses may be only given once per day, especially in children.

Adderall XR capsules come in 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg sustained-release strengths. Adderall XR lasts about 12 hours. Like Azstarys, Adderall XR can be dosed once per day (in the morning) which helps to avoid administration at school. If needed, the beads inside the capsule can be sprinkled on applesauce for children. Do not chew the beads.

Adderall or Adderall XR can be taken with or without food.

How do the side effects compare between Azstarys and Adderall?

Side effects occur with most drugs but people do not usually experience all of the side effects listed.

Common side effects

Azstarys and Adderall / Adderall XR are all CNS stimulants and share side effects that are similar. CNS stimulants can commonly cause:

• Decreased appetite
• Trouble sleeping
• Stomach ache
• Weight loss
• Dizziness
• Mood changes
• Increased heart rate or blood pressure
• Nausea, vomiting
• Heartburn or indigestion
• Anxiety
• Irritability
• Nervousness
• Headache
• Dry mouth

Serious side effects

Serious side effects with CNS stimulants like Azstarys or Adderall can include:

• Drug abuse and dependence
• Painful and prolonged erections (priapism)
• Circulation problems in fingers and toes
• Slowing of growth (height and weight) in children
• Heart problems (sudden death, stroke, and heart attack)
• Increased heart rate
• Increased blood pressure
• Mental (psychiatric) problems (new or worsened bipolar illness, new psychotic symptoms)

This is not a complete list of the possible side effects with Azstarys or Adderall. It is important to talk with your doctor about the possible symptoms of serious and common side effects, and understand what action you need to take if you experience one.

Learn more: Azstarys or Adderall side effects (in more detail)

Which is more expensive, Azstarys or Adderall?

• Azstarys was approved in March 2021 and the cash price for 30 capsules is about $410. There is no generic option at this time.
• The cash price for 100 generic Adderall 5 mg tablets costs about $14.00. Although brand name Adderall has been discontinued, the pharmacy may still have some in stock. The cash price for 100 tablets of brand name is Adderall 5 mg is $953.
• The cash price for 30 capsules of generic Adderall XR 10 mg costs about $58 and the brand name costs about $230.

If you are eligible, the CoriumCares program from the Azstarys manufacturer may be able to provide copay assistance or other financial support. Eligible patients pay $0 for their first prescription. For refills, patients pay $25 if their insurance covers the medicine or $50 if their insurance does not cover it. Azstarys is manufactured by KemPharm and they can be contacted at 1-800-910-8432.

The immediate-release brand name Adderall tablets have been discontinued in the U.S. but are still available as a generic option. The brand name Adderall XR capsules are still on the market and also come as a generic option.

Generic Adderall and Adderall XR are made by various manufacturers. Brand name Adderall XR is made by Takeda Pharmaceuticals.

This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.

Related: Try the Drugs.com Comparison Tool - Compare Azstarys, Adderall and Adderall XR

This is not all the information you need to know about Azstarys and Adderall / Adderall XR for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.