Vyvanse Follow-Up Monitoring Schedule
For patients newly started on Vyvanse, maintain weekly contact (in-person or by phone) during the initial 2-4 week titration phase, then schedule at least monthly appointments until symptoms are stabilized. 1
Initial Titration Phase (Weeks 1-4)
During dose optimization, the following schedule applies:
- Weekly contact (office visit or telephone) to assess response and side effects 1
- The titration period typically requires 2-4 weeks to reach optimal dosing 1
- Vyvanse is initiated at 30 mg daily, with weekly increases of 20 mg until optimal dose is achieved (maximum 70 mg/day) 2
What to Monitor Weekly During Titration:
Target Symptoms:
- ADHD Rating Scale scores from parents/teachers (for children/adolescents) 1
- Self-ratings from adolescents and adults 1
- Clinical Global Impression scores 2
Side Effects - Ask Specifically About:
- Insomnia and sleep onset delay 1
- Decreased appetite/anorexia 1
- Headaches 1
- Stomachache 1
- Social withdrawal 1
- Tics 1
- Jitteriness 1
Physical Parameters at Each Visit:
- Weight (objective measure of appetite suppression) 1
- Blood pressure 3
- Pulse/heart rate 3
- Height (baseline and periodic) 3
Maintenance Phase (After Dose Stabilization)
Once optimal dose is established, schedule appointments at least monthly until symptoms are fully stabilized. 1 After stabilization, visit frequency should be determined by:
- Robustness of drug response
- Medication adherence
- Presence and severity of side effects
- Comorbid psychiatric conditions
- Need for psychoeducation or psychosocial interventions 1
Increase Visit Frequency If:
- Side effects emerge or worsen
- Significant comorbid psychiatric disorders present
- Problems with medication adherence
- Symptom severity increases 1
Long-Term Monitoring Considerations
Essential ongoing assessments:
- Continue monitoring height, weight, blood pressure, and pulse at each visit 3
- Systematically screen for cardiovascular effects (lisdexamfetamine increases blood pressure and pulse) 3
- Monitor for decreased appetite and weight loss throughout treatment 3
For adolescents specifically:
- Screen for substance use, anxiety, depression, and learning disabilities at minimum 4
- These comorbidities affect treatment sequencing and require monitoring for stimulant misuse or suicidal ideation 4
Common Pitfalls to Avoid
Don't rely solely on parent reports - obtain teacher ratings for school-age children and self-ratings from adolescents/adults 1
Don't skip weight measurements - this is your objective measure of appetite suppression and should be done at every visit 1
Don't assume side effects require discontinuation - most are dose-responsive and can be managed by adjusting timing or lowering the dose 1
Don't forget telephone contact counts - weekly monitoring during titration can be maintained by phone rather than requiring office visits 1
Recognize ADHD as a chronic condition - manage using chronic care model principles with ongoing follow-up, not just acute treatment 4
The evidence strongly supports structured, frequent monitoring during initiation with gradual transition to less frequent but consistent long-term follow-up, treating ADHD as the chronic condition it represents.