What are the contraindications for Vyvanse (lisdexamfetamine)?

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Contraindications for Vyvanse (Lisdexamfetamine)

Vyvanse is absolutely contraindicated in two situations: patients with known hypersensitivity to amphetamine products or any ingredient in Vyvanse, and patients currently taking or who have taken MAO inhibitors within the past 14 days. 1

Absolute Contraindications

1. Hypersensitivity Reactions

  • Known hypersensitivity to amphetamine products or any ingredient in Vyvanse
  • This includes patients with prior history of:
    • Anaphylactic reactions
    • Stevens-Johnson Syndrome
    • Angioedema
    • Urticaria 1

2. MAO Inhibitor Use

  • Concurrent use with MAOIs or within 14 days of stopping MAOIs
  • This includes MAOIs such as linezolid or intravenous methylene blue
  • Critical reason: Risk of hypertensive crisis and potential cerebrovascular accident 2, 1

Additional Clinical Contraindications from Stimulant Guidelines

While the FDA label specifies only two absolute contraindications, clinical practice guidelines identify additional situations where Vyvanse should not be used 2:

Psychiatric Contraindications

  • Active psychotic disorders: Schizophrenia, psychosis NOS, or manic episodes with psychosis
  • Stimulants are known psychotomimetics and will exacerbate psychotic symptoms 2

Cardiovascular Contraindications

  • Serious structural cardiac abnormalities or serious cardiac disease
  • Risk of sudden death in patients with underlying heart problems or heart defects 3, 1
  • This includes:
    • Cardiomyopathy
    • Serious cardiac arrhythmias
    • Coronary artery disease

Other Contraindications

  • Glaucoma: Sympathomimetics may increase intraocular pressure 2, 3, 2, 3
  • Uncontrolled hypertension 3
  • Hyperthyroidism 3
  • Agitated states 3

Important Clinical Caveats

Not Absolute Contraindications (Despite Package Insert Warnings)

Recent evidence suggests these conditions may NOT be absolute contraindications 2:

  • Motor tics or Tourette's syndrome: Controlled studies have not found that stimulants consistently worsen tics
  • History of substance abuse: While requiring careful monitoring, even prior stimulant abuse may not represent an absolute contraindication if the patient can be supervised closely

Conditions Requiring Extreme Caution

  • Drug dependence history: Black box warning exists, but patients can be treated with intensive monitoring 2
  • Peripheral vasculopathy: May worsen conditions including Raynaud phenomenon 3

Monitoring Requirements When Prescribing

Even when not contraindicated, monitor for:

  • Blood pressure and heart rate elevation (mean increase 2-4 mmHg BP, 3-6 bpm HR) 1
  • Emergence of psychotic or manic symptoms 1
  • Signs of abuse, misuse, or addiction 1

References

2
Guideline

practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults.

Journal of the American Academy of Child and Adolescent Psychiatry, 2002

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.