What is the recommended dosage of Vyvanse (Lisdexamfetamine)?

From the Guidelines

Vyvanse dosage should be initiated at 20-30 mg orally once daily in the morning, with titration by 10 mg weekly to a maximum of 70 mg daily, as recommended by the most recent study 1. When determining the optimal dosage, it's essential to consider the individual patient's response and tolerability. The effective dose range is typically between 30-70mg daily for most patients.

• Key considerations for dosage adjustments include:
  • Starting dose: 20-30 mg orally once daily in the morning
  • Titration: increase by 10 mg weekly
  • Maximum recommended dose: 70 mg per day
• It's crucial to monitor patients for potential side effects, such as decreased appetite, insomnia, and dry mouth, and adjust the dosage accordingly to minimize these effects.
• Patients should be advised to take Vyvanse in the morning to avoid sleep disturbances and can take it with or without food.
• The medication's mechanism of action involves converting to dextroamphetamine in the body, which increases dopamine and norepinephrine levels in the brain to improve focus and reduce impulsivity, as noted in the study 1.
• Special considerations, such as kidney impairment, may require dosage adjustments, and lower starting doses are recommended for those new to stimulant medications.
• Patients should work closely with their healthcare provider to find the optimal dose that balances symptom control with minimal side effects, and avoid abruptly stopping Vyvanse.

From the FDA Drug Label

2.3 Dosage for Treatment of ADHD The recommended starting dosage in adults and pediatric patients 6 years and older is 30 mg once daily in the morning. Dosage may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals up to maximum recommended dosage of 70 mg once daily 2.4 Dosage for Treatment of Moderate to Severe BED in Adults The recommended starting dosage in adults is 30 mg once daily to be titrated in increments of 20 mg at approximately weekly intervals to achieve the recommended target dose of 50 mg to 70 mg once daily. The maximum recommended dosage is 70 mg once daily

The recommended dosage of Vyvanse is:

• For ADHD: 30 mg once daily, adjustable in increments of 10 mg or 20 mg at approximately weekly intervals up to a maximum of 70 mg once daily 2
• For moderate to severe BED in adults: 30 mg once daily, titrated in increments of 20 mg at approximately weekly intervals to achieve a target dose of 50 mg to 70 mg once daily, with a maximum recommended dosage of 70 mg once daily 2 Key considerations:
• Dosage adjustments should be made at approximately weekly intervals
• The maximum recommended dosage is 70 mg once daily
• Patients with severe renal impairment should not exceed 50 mg once daily, and those with end-stage renal disease should not exceed 30 mg once daily 2

From the Research

Vyvanse Dosage

• The recommended dose range for Vyvanse (lisdexamfetamine) is 50-70 mg/day for the treatment of moderate to severe binge eating disorder (BED) in adults 3, 4, 5.
• Studies have shown that doses of 50 and 70 mg/day are effective in reducing binge eating days per week, with effect sizes ranging from 0.83 to 0.97 4, 5.
• A systematic review and meta-analysis found consistent evidence that lisdexamfetamine is an effective treatment for BED, with a significant reduction in BED symptoms and body weight 6.
• The number needed to treat (NNT) for response, as defined by a Clinical Global Impressions-Improvement score of 'very much improved' or 'much improved', was 3 (95% CI 3-4) for lisdexamfetamine vs. placebo 5.
• The most common adverse events (AEs) associated with lisdexamfetamine were dry mouth, decreased appetite, insomnia, and headache, with number needed to harm (NNH) values vs. placebo of 4 (95% CI 3-5), 11 (95% CI 8-17), 11 (95% CI 8-18), and 19 (95% CI 11-75), respectively 5.

Efficacy and Safety

• Lisdexamfetamine has been shown to be effective in reducing binge eating days per week, with a significant reduction in BED symptoms and body weight 3, 4, 6.
• The safety profile of lisdexamfetamine is generally consistent with previous findings in adults with attention-deficit/hyperactivity disorder (ADHD), with the most common AEs being dry mouth, decreased appetite, insomnia, and headache 3, 4, 5.
• Discontinuation rates due to AEs were low, with an NNH for discontinuation due to an AE for lisdexamfetamine vs. placebo of 44 (95% CI 23-1971) 5.

Mechanism of Action

• The exact mechanism of action of lisdexamfetamine in treating BED is not fully understood, but it is thought to involve a combination of effects on appetite/satiety, reward, and cognitive processes, including attention and impulsivity/inhibition, mediated by catecholamine and serotonin mechanisms in the brain 6, 7.
• An experimental medicine study found that lisdexamfetamine reduced self-reported appetite ratings and intake of both a pasta meal and a palatable cookie snack, and decreased the eating rate of pasta but not of cookies 7.