Daytrana vs. Xelstrym for ADHD: How Do They Compare?

Attention deficit-hyperactivity disorder (ADHD) is a medical condition that affects the way the brain works. It’s usually diagnosed during childhood, but it can affect adults as well.

Medication options for ADHD fall into one of two categories: stimulant medications and non-stimulant medications. 

Stimulants are the most commonly used medications to treat ADHD. They include oral medications like Adderall (amphetamine salt combo) and Ritalin (methylphenidate). But taking a pill by mouth isn’t the best option for some people.

Daytrana (methylphenidate) and Xelstrym (dextroamphetamine) are two stimulant medications that come as a patch to be applied to the skin. Below, we’ll compare Daytrana and Xelstrym for ADHD. 

What is Daytrana?

Daytrana is a long-acting medication that comes as a patch you apply to the skin. It contains methylphenidate and is used to treat ADHD. 

Daytrana is FDA-approved to treat ADHD in children and adolescents ages 6 to 17 years old. It’s not FDA-approved for use in adults. It’s only available as a brand-name medication in the following dosages:

• 10 mg

• 15 mg

• 20 mg

• 30 mg

How does Daytrana work for ADHD? 

We don’t know exactly how Daytrana works for ADHD. But stimulants like Daytrana raise the amount of certain chemicals in the brain. These chemicals are called norepinephrine and dopamine. Higher amounts of them can lead to greater energy, alertness, and attention.

What is Xelstrym?

Xelstrym is a new ADHD medication that was FDA-approved in March 2022. It isn’t yet available on the market, but it may become available sometime in 2022. 

Like Daytrana, Xelstrym is a stimulant medication. It also comes as a patch. Xelstrym contains dextroamphetamine, which is in the category of stimulants called amphetamines. 

Like Daytrana, Xelstrym is FDA-approved to treat ADHD in children ages 6 years and older. However, Xelstrym is also approved to treat adults with ADHD. Xelstrym will only be available as a brand-name product in the following dosages:

• 4.5 mg

• 9 mg

• 13.5 mg

• 18 mg

How does Xelstrym work for ADHD? 

It’s not clear how Xelstrym works for ADHD. But like Daytrana, Xelstrym raises norepinephrine and dopamine levels in the brain. This can lead to more focus and a greater attention span. 

How are Daytrana and Xelstrym dosed?

Both Daytrana and Xelstrym are once-daily patches you apply to the skin. They should be applied 2 hours in advance of when you want to see the effects. They can be worn for up to 9 hours.

The starting dose of Daytrana is usually 10 mg applied to the hip. You should alternate hips each time you apply Daytrana. The dose can be raised weekly until the desired effect is achieved. The maximum dose is 30 mg daily.

The starting dose of Xelstrym for children, ages 6 to 17 years old, is 4.5 mg. For adults, it’s 9 mg. The maximum recommended dose for children and adults is 18 mg. Xelstrym can be applied to the following areas:

• Hip

• Upper arm

• Chest

• Upper back

• On the side or back of your body between the ribs and hip (flank)

You should pick a different application site for Xelstrym each day to avoid skin irritation.

How effective are Daytrana and Xelstrym for treating ADHD?

Three studies led to Daytrana’s FDA approval. Two studies included children ages 6 to 12 years old, and the third study included teenagers ages 13 to 17 years old. All three studies showed that Daytrana was better than a placebo patch (a patch with no medication in it) at treating ADHD symptoms.

Xelstrym was also studied in 6 to 17 years old. It was better at treating symptoms of ADHD than a placebo patch. Xelstrym hasn’t been studied in adults. But another amphetamine medication — lisdexamfetamine — is well-studied in adults. Since Xelstrym is similar to lisdexamfetamine, the results of these studies were used to get Xelstrym FDA-approved in adults. 

For now, there are no studies comparing Daytrana and Xelstrym to one another. Talk to your healthcare provider if you think one of these medications would be helpful for you or your child’s ADHD. They can help you pick the best treatment option.

What are the side effects of Daytrana and Xelstrym?

Daytrana and Xelstrym have some common side effects, including:

• Skin irritation

• Lowered appetite

• Nausea

• Vomiting

• Stomach pain

• Sudden, repetitive movements (tics)

• Trouble sleeping

• Moodiness

What are the serious side effects of Daytrana and Xelstrym?

Daytrana and Xelstrym can have more serious side effects, too. These include: 

• Potential for dependence or misuse: Xelstrym and Daytrana are Schedule II controlled substances. This means they have a higher potential for dependence and misuse. Daytrana and Xelstrym are less likely to cause dependence and misuse than other stimulants that are shorter-acting. Still, it’s recommended to avoid using these medications if you have a history of drug or alcohol misuse. And you should only use Daytrana and Xelstrym as directed by your healthcare provider.

• Heart problems: Daytrana and Xelstrym can cause heart problems like high blood pressure, stroke, or heart attack. You’re more at risk for these side effects if you or your child already have heart problems. This includes an abnormal heart rhythm like atrial fibrillation.

• Psychiatric symptoms: If you or your child has been diagnosed with bipolar disorder, Xelstrym and Daytrana may make symptoms worse. It can also cause new or worsening psychosis, aggressive behavior, or depression. Talk to your healthcare provider immediately if you experience any mood changes or suicidal thoughts.

• Slowed growth in children: Stimulants may lead to weight loss and slowed growth in children. If your child isn’t growing as expected, or losing weight during treatment, talk to their healthcare provider.

• Circulation problems: Daytrana and Xelstrym can make it harder for blood to reach your fingers and toes (Raynaud’s phenomenon). This may cause tingling or numbness in the hands and feet. This is rare and usually goes away once the medication is stopped.

• Skin reactions: Daytrana and Xelstrym can cause severe allergic skin reactions that show up as a rash, swelling, or blisters. Daytrana can also cause a loss of skin color in the area where it’s placed, which can be permanent. 

Daytrana can also raise your chance of having seizures, especially if you have a history of seizure disorder (epilepsy). It can also cause painful and prolonged erections (priapism). 

Xelstrym can cause serotonin syndrome, which occurs when there’s too much serotonin in the body. This is more likely to occur if you take other medications that affect serotonin levels, like selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).

What interactions do Daytrana and Xelstrym have?

Daytrana and Xelstrym may interact with other medications. Make sure to show your pharmacist and healthcare provider a list of your current medications. They can help you figure out if you’re at risk of any drug interactions. 

Daytrana may interact with:

• Some antidepressants, including SSRIs, TCAs, and monoamine oxidase inhibitors (MAOIs) 

• Medications that raise blood pressure, like phenylephrine (Sudafed PE)

• Medications that lower blood pressure, like angiotensin-converting enzyme (ACE) inhibitors

• Some seizure medications, like phenobarbital, phenytoin (Dilantin), and primidone (Mysoline)

• Warfarin (Coumadin, Jantoven)

• Risperidone (Risperdal)

Xelstrym can interact with medications that are CYP2D6 inhibitors. CYP2D6 is an enzyme (protein) that changes some medications, like amphetamines, into their active form. Examples of CYP2D6 inhibitors include SSRIs, bupropion (Wellbutrin XL, Wellbutrin SR), and diphenhydramine (Benadryl).

Xelstrym can also interact with medications that lower the acidity of the urine. These medications can raise levels of Xelstrym in the body. These include medications like Urocit-K (potassium citrate) and Cytra-K (potassium citrate/citric acid).

Can I take Daytrana and Xelstrym together for ADHD?

No, you shouldn't use Daytrana and Xelstrym patches together.

If you use them at the same time, you or your child are at greater risk for serious side effects. If you’re using Daytrana or Xelstrym and it’s not working, talk to your healthcare provider or your child’s provider. 

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Written by:

Sarah Lobello Pearson, PharmD

Sarah Pearson is a practicing pharmacist with over 10 years of experience in the field. She received her doctorate in pharmacy from the University of Georgia in Athens, GA.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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