What is the recommended titration for Vyvanse (Lisdexamfetamine) for Attention Deficit Hyperactivity Disorder (ADHD) patients, and what are the associated side effects?

From the Guidelines

Vyvanse (lisdexamfetamine) titration for ADHD typically begins with 20-30mg once daily in the morning, with gradual increases of 10mg weekly as needed until optimal response is achieved, usually not exceeding 70mg daily, as recommended by the most recent study 1.

Key Considerations

• The starting dose for children ages 6-12 may be 20-30mg, while adolescents and adults typically start at 30mg.
• Dose adjustments should be made based on symptom control and side effects, with careful monitoring of potential adverse effects such as decreased appetite, weight loss, insomnia, dry mouth, increased heart rate, anxiety, and irritability.
• More serious but less common side effects include cardiovascular issues (hypertension, tachycardia), psychiatric symptoms (agitation, mood changes), and growth suppression in children.

Administration and Monitoring

• Patients should take Vyvanse in the morning to minimize sleep disruption.
• Acidic foods/drinks should be avoided within an hour of taking Vyvanse, as they can reduce absorption.
• Regular follow-ups with the healthcare provider are essential to monitor effectiveness and side effects.

Mechanism of Action

• Vyvanse works by being converted to dextroamphetamine in the body, which increases dopamine and norepinephrine levels in the brain, improving attention and reducing hyperactivity and impulsivity in ADHD patients.

Comparison with Other Medications

• According to a study on evidence-based pharmacological treatment options for ADHD in children and adolescents 1, stimulants like Vyvanse are generally recommended as first-line therapy, with non-stimulants as second-line therapy.
• The choice of medication should consider individual factors, such as severity of symptoms, presence of comorbidities, and patient preferences.

From the FDA Drug Label

The primary efficacy outcome was change in Total Score from baseline to endpoint in investigator ratings on the ADHD Rating Scale (ADHD-RS). All patients receiving lisdexamfetamine dimesylate capsules were initiated on 30 mg for the first week of treatment. Patients assigned to the 50 mg and 70 mg dose groups were titrated by 20 mg per week until they achieved their assigned dose.

The recommended titration for Vyvanse for ADHD patients is to initiate treatment at 30 mg for the first week, and then titrate by 20 mg per week until the assigned dose is reached. Side effects are not directly mentioned in the provided text as related to the titration schedule, but it can be inferred that the titration schedule is designed to minimize side effects by gradually increasing the dose. Key points to consider:

• Initial dose: 30 mg
• Titration increment: 20 mg per week
• Maximum dose: 50 mg or 70 mg, depending on the patient's response and tolerability. 2 2

From the Research

Recommended Titration for Vyvanse (Lisdexamfetamine) in ADHD Patients

• The recommended titration for Vyvanse is not explicitly stated in the provided studies, but the efficacy and safety of lisdexamfetamine dimesylate have been evaluated in several studies 3, 4, 5.
• Lisdexamfetamine has been shown to have a high efficacy and a relatively lower rate of adverse effects compared to other medications for ADHD 4.
• The dosage of lisdexamfetamine is typically adjusted based on the patient's response and tolerability, with a usual dosage range of 30-70 mg per day 3.

Side Effects of Vyvanse (Lisdexamfetamine) in ADHD Patients

• Common side effects of lisdexamfetamine include decreased appetite, insomnia, abdominal pain, and irritability 3, 5.
• Lisdexamfetamine has been shown to have a tolerability profile consistent with other stimulant medications, with most side effects being mild to moderate in intensity and transient in nature 3.
• However, amphetamines, including lisdexamfetamine, have been found to be inferior to placebo in terms of tolerability in both children and adolescents and adults, with a higher risk of side effects such as anxiety, agitation, and insomnia 5.

Comparison with Other ADHD Medications

• Lisdexamfetamine has been compared to other ADHD medications, including methylphenidate, atomoxetine, and guanfacine, in terms of efficacy and safety 4, 6, 5.
• Methylphenidate has been found to have a lower incidence rate of adverse effects and a higher efficacy compared to lisdexamfetamine in some studies 4, 5.
• Atomoxetine has been found to have a lower efficacy compared to lisdexamfetamine and methylphenidate, but a lower incidence rate of all-cause withdrawals 4.