Vyvanse Starting Dose
The recommended starting dose of Vyvanse (lisdexamfetamine) is 30 mg once daily in the morning for both adults and children 6 years and older with ADHD. 1
Dosing Algorithm
Initial Dosing
- Start at 30 mg once daily in the morning, with or without food 1
- This applies uniformly to:
- Children ≥6 years old
- Adolescents
- Adults
Titration Schedule
After the initial 30 mg dose, increase in increments of 10 mg or 20 mg at approximately weekly intervals based on clinical response and tolerability 1. The maximum recommended dose is 70 mg once daily 1.
Administration Considerations
- Take in the morning to avoid insomnia 1
- Can be swallowed whole as capsule, or contents mixed with yogurt, water, or orange juice 1
- Chewable tablets must be chewed thoroughly before swallowing 1
- Do not divide doses - use one complete capsule or tablet per day 1
Special Populations
Renal Impairment
Dose adjustments are required 1:
- Severe renal impairment (GFR 15-30 mL/min/1.73 m²): Maximum 50 mg daily
- End-stage renal disease (GFR <15 mL/min/1.73 m²): Maximum 30 mg daily
Preschool Children (Ages 4-5 Years)
While lisdexamfetamine has been studied in preschoolers starting at doses as low as 5 mg 2, it is not FDA-approved for children under 6 years. The 2011 AAP guidelines note that lisdexamfetamine has lower abuse potential, making it suitable for adolescents at risk for diversion 3, but do not provide specific dosing recommendations for preschoolers.
Clinical Context
The 30 mg starting dose represents a departure from older amphetamine dosing guidelines. Historical practice parameters from 2002 recommended starting dextroamphetamine/amphetamine at 2.5 mg 4. However, lisdexamfetamine is a prodrug that requires metabolic conversion to dextroamphetamine by red blood cells 3, which explains the higher starting dose compared to immediate-release amphetamines.
Evidence Base
Multiple studies support the 30 mg starting dose:
- Adult studies demonstrated efficacy at 30 mg, 50 mg, and 70 mg doses with significant improvements over placebo beginning at week 1 5
- Pediatric studies showed efficacy from 1.5 to 13 hours post-dose across the dose range 6, 7
- Effect sizes were substantial (SKAMP deportment effect size of -1.73) 7
Important Caveats
Pre-Treatment Assessment
Before initiating Vyvanse, assess for 1:
- Cardiac disease through careful history, family history of sudden death/ventricular arrhythmia, and physical exam
- Motor or verbal tics or Tourette's syndrome through family history and clinical evaluation
- Substance abuse risk, particularly in adolescents 3
Monitoring Parameters
- Height and weight (growth attenuation can occur, particularly with early initiation) 8
- Blood pressure and pulse
- Symptoms of abuse, misuse, or diversion 1
Advantages of Lisdexamfetamine
The prodrug formulation offers lower abuse potential compared to other amphetamines because it requires metabolic activation and cannot be effectively extracted for intranasal or intravenous abuse 3. This makes it particularly appropriate for adolescents and patients with substance use concerns 9.
The 30 mg starting dose allows for straightforward titration in 10-20 mg increments weekly until optimal response is achieved, typically within 2-4 weeks of dose adjustment 1.