What is the recommended treatment and dosage of Lisdexamfetamine (Vyvanse) for Attention Deficit Hyperactivity Disorder (ADHD) and binge eating disorder?

From the Guidelines

Lisdexamfetamine (Vyvanse) is typically started at 30mg once daily in the morning for both ADHD and binge eating disorder, with dosage adjustments made in 10-20mg increments at weekly intervals. For ADHD, the recommended dose range is 30-70mg daily, while for binge eating disorder, the target dose is usually 50-70mg daily. The medication should be taken in the morning to avoid sleep disturbances, and can be swallowed as a capsule or dissolved in water. Patients should be aware that Vyvanse is a controlled substance with potential for dependence, and common side effects include decreased appetite, insomnia, dry mouth, and increased heart rate or blood pressure. Regular monitoring of vital signs, growth (in children), and mental health status is necessary, as recommended by the American Psychiatric Association 1. Vyvanse works by increasing dopamine and norepinephrine levels in the brain, which improves attention, reduces impulsivity, and helps control binge eating behaviors by regulating reward pathways. The medication should not be stopped abruptly, and dosage should be individualized based on response and tolerability under medical supervision, with consideration of factors such as severity of symptoms, presence of comorbidities, and patient preferences 1. It is also important to note that medication adherence is a common problem in ADHD treatment, and regular assessment and open discussion of potential issues can help increase adherence 1. In terms of specific dosing regimens, once-daily dosing is generally preferred over twice-daily dosing, and the dosing regimen can affect medication adherence 1. Overall, the use of lisdexamfetamine for ADHD and binge eating disorder should be guided by the most recent and highest quality evidence, with consideration of individual patient factors and careful monitoring of response and tolerability 1.

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 treatment and dosage of Lisdexamfetamine (Vyvanse) for:

• Attention Deficit Hyperactivity Disorder (ADHD): 30 mg once daily in the morning, adjustable in increments of 10 mg or 20 mg at approximately weekly intervals up to a maximum of 70 mg once daily.
• Binge Eating Disorder (BED): 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.

From the Research

Lisdexamfetamine (Vyvanse) for Attention Deficit Hyperactivity Disorder (ADHD) and Binge Eating Disorder

• Lisdexamfetamine is a prodrug of dextroamfetamine, approved in the USA for the treatment of moderate to severe binge eating disorder (BED) in adult patients 3.
• The recommended dosage of lisdexamfetamine for BED is 50-70 mg/day, which has been shown to be effective in reducing binge eating days/week 3.
• For ADHD, lisdexamfetamine has been approved for use in adults, with a convenient once-daily oral regimen, offering improved adherence and reduced abuse compared to short-acting preparations of amfetamines 4.
• The efficacy of lisdexamfetamine in adults with moderate to severe ADHD has been demonstrated in several studies, with significant improvements noted in ADHD rating scales, Clinical Global Improvement scores, and assessments of executive function, for all doses of lisdexamfetamine (30-70 mg daily) 5.
• Lisdexamfetamine has also been shown to be safe and efficacious in the treatment of ADHD in children and adolescents, with the most commonly exhibited side effects being appetite suppression, weight loss, headache, and insomnia 6.
• The clinical efficacy, safety, and tolerability of lisdexamfetamine in the treatment of BED have been established in clinical trials, with commonly reported side effects including dry mouth, insomnia, weight loss, and headache 7.

Dosage and Administration

• The recommended dosage of lisdexamfetamine for BED is 50-70 mg/day 3.
• For ADHD, the dosage of lisdexamfetamine is typically in the range of 30-70 mg daily 4, 5.
• Lisdexamfetamine should be administered orally, once daily, in the morning 4, 5.

Safety and Tolerability

• Lisdexamfetamine has been generally well tolerated in clinical trials, with a tolerability profile similar to that observed in ADHD patients 3.
• The most common treatment-emergent adverse events (TEAEs) in phase III trials included dry mouth, headache, and insomnia 3.
• Lisdexamfetamine should be avoided in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmia, or coronary artery disease 7.
• As with all CNS stimulants, the risk of abuse needs to be assessed prior to prescribing lisdexamfetamine 7.