From the Guidelines
When transitioning from 40mg Adderall XR to Vyvanse due to reduced effectiveness, a starting dose of 30mg Vyvanse would be appropriate, as the usual starting dose is 20-30 mg po qam, according to the most recent study 1. This recommendation is based on the study published in the American Journal of Obstetrics and Gynecology in 2024, which provides guidance on the treatment of attention-deficit/hyperactivity disorder (ADHD) with psychostimulants like Vyvanse. Some key points to consider when starting Vyvanse include:
- The medication should be taken once daily in the morning, as it has a duration of action of 10-14 hours.
- The dose can be titrated by increasing it by 10 mg weekly to a maximum of 70 mg daily, as needed and under the supervision of a healthcare provider.
- Common side effects of Vyvanse include decreased appetite, insomnia, and dry mouth, which should be monitored and addressed if they occur.
- It is essential to work closely with a healthcare provider to adjust the dose and manage any side effects, as individual responses to the medication can vary. The study 1 provides valuable information on the use of Vyvanse in the treatment of ADHD, and its findings support the use of a starting dose of 30mg when transitioning from Adderall XR.
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
The dose of Vyvanse to start if 40mg of Adderall XR is less effective is 30 mg once daily.
- This is the recommended starting dosage for ADHD treatment in adults and pediatric patients 6 years and older.
- Dosage may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals up to a maximum recommended dosage of 70 mg once daily 2.
From the Research
Dose Conversion from Adderall XR to Vyvanse
When considering a switch from Adderall XR to Vyvanse due to reduced efficacy of 40mg Adderall XR, it's essential to understand the pharmacological differences between these two medications.
- Adderall XR is a mixed amphetamine salt, while Vyvanse is a prodrug of d-amphetamine, known as lisdexamfetamine.
- The dosing and efficacy of these medications can vary significantly among individuals.
Clinical Evidence for Dosing
Based on the provided studies:
- There is no direct evidence comparing the dose conversion from Adderall XR to Vyvanse 3, 4, 5, 6, 7.
- However, it is known that lisdexamfetamine (Vyvanse) is typically started at a dose of 30mg once daily, with the option to titrate up to 50mg or 70mg based on efficacy and tolerability 4, 6.
Considerations for Starting Dose
Given the lack of direct comparison data, the starting dose of Vyvanse when switching from 40mg Adderall XR should be approached cautiously:
- A reasonable starting point might be 30mg of Vyvanse, considering its pharmacokinetics and the need for individual titration 4, 6.
- It's crucial to monitor the patient's response and adjust the dose as necessary to achieve optimal efficacy while minimizing side effects.
Safety and Efficacy
Both Adderall XR and Vyvanse have demonstrated efficacy in the treatment of ADHD, with common side effects including decreased appetite, insomnia, and weight loss 3, 4, 5, 6, 7.
- The choice of medication and dosing should be based on individual patient factors, including medical history, response to previous treatments, and potential for abuse 7.