Vyvanse Dosage Range
For ADHD in patients aged 6 years and older, Vyvanse should be started at 30 mg once daily in the morning, with weekly titration in 10-20 mg increments to a therapeutic range of 30-70 mg/day, with a maximum dose of 70 mg/day. 1
Starting Dose and Titration Schedule
- Initial dose: 30 mg once daily every morning 1
- Titration: Increase by 10 mg or 20 mg weekly based on response and tolerability 1
- Therapeutic range: 30-70 mg per day 1
- Maximum dose: 70 mg per day 1
This FDA-approved dosing differs from older amphetamine guidelines that recommended starting at 2.5 mg for immediate-release dextroamphetamine/amphetamine 2. However, those guidelines predate Vyvanse (approved 2007) and apply to immediate-release formulations requiring multiple daily doses. Vyvanse is a prodrug of dextroamphetamine with once-daily dosing, requiring higher starting doses due to its unique pharmacokinetic profile.
Special Population Adjustments
Renal impairment requires dose reduction:
- Severe renal impairment (GFR 15-29 mL/min): Maximum 50 mg/day 1
- End-stage renal disease (ESRD, GFR <15 mL/min): Maximum 30 mg/day 1
Duration of Effect and Efficacy
Vyvanse demonstrates efficacy up to 14 hours post-dose in adults 3, providing full-day symptom control including late afternoon and early evening 4. Clinical trials show significant improvements in ADHD Rating Scale-IV scores across all approved doses (30,50,70 mg) compared to placebo, with effect sizes ranging from -0.43 to -0.52 1, 5, 6.
Dose-Response Considerations
Recent network meta-analysis data suggest that for amphetamines generally, efficacy plateaus around 25 mg/day with adverse event-related discontinuation rising steadily at higher doses 7. The optimal net clinical benefit for amphetamines occurs at approximately 12-26 mg/day (peak 18-20 mg/day) when balancing efficacy against tolerability 7. However, this applies to immediate-release amphetamine equivalents, not Vyvanse specifically, where the prodrug conversion results in different dosing requirements.
Monitoring Requirements
Before initiating treatment, obtain baseline:
- Blood pressure and pulse 2
- Height and weight 2
- Cardiac assessment to rule out symptomatic cardiovascular disease 2
During titration (weeks 1-4):
- Weekly contact (visit or phone) to assess response and side effects 2
- Use ADHD rating scales from parents/teachers for children, self-ratings for adolescents/adults 2
Maintenance phase:
- Monthly visits until symptoms stabilized 2
- Quarterly blood pressure and pulse checks for adults 2
- Annual vital signs and growth monitoring for children 2
Common Pitfalls to Avoid
Do not start below 30 mg thinking lower is safer—this is the FDA-approved starting dose for Vyvanse specifically, not applicable to other amphetamine formulations 1.
Do not exceed 70 mg/day even if symptoms persist. If inadequate response at maximum dose, consider switching medications rather than increasing further 2. More is not necessarily better.
Do not use in patients with:
- Symptomatic cardiovascular disease or hypertension 2
- Active psychotic disorder 2
- Concurrent MAO inhibitor use 2
- History of stimulant abuse (unless closely supervised) 2
Safety Profile
Most common adverse events (>10% incidence) include decreased appetite, weight decrease, irritability, insomnia, headache, and upper abdominal pain 8, 9. These typically emerge within the first 4-12 weeks and may diminish over time 8. Long-term studies up to 2 years show maintained efficacy with acceptable tolerability, though growth parameters (height, weight, BMI) show modest reductions with shifts to lower z-score categories 8.