How to transition from Vyvanse (lisdexamfetamine) to Strattera (atomoxetine)?

From the Guidelines

Transitioning from Vyvanse to Strattera should be done under close medical supervision, with a recommended cross-titration approach to minimize potential withdrawal effects and side effects. When transitioning from Vyvanse (lisdexamfetamine) to Strattera (atomoxetine), it's crucial to consider the different mechanisms of action and pharmacokinetics of these medications. Vyvanse is a stimulant that increases dopamine and norepinephrine levels, whereas Strattera is a non-stimulant that primarily affects norepinephrine levels 1. The cross-titration approach typically involves gradually reducing the dose of Vyvanse while slowly increasing the dose of Strattera. A common schedule might involve reducing Vyvanse by 10-20mg weekly while starting Strattera at 40mg daily for the first week, then increasing to 80mg daily in the second week, potentially reaching the target dose of 80-100mg daily by week 3-4 1. Some key points to consider during this transition include:

• Strattera takes 2-4 weeks to reach full effectiveness, so patients may experience a temporary gap in symptom control during the transition 1.
• Side effects during this period may include nausea, fatigue, dry mouth, or sleep disturbances, which should be reported to the doctor immediately 1.
• The transition is necessary because Vyvanse and Strattera have different mechanisms of action and require different adjustment periods and dosing strategies 1.
• It's essential to monitor patients for potential cardiovascular risks, such as changes in heart rate and blood pressure, when transitioning between these medications 1.
• A trustful physician-patient relationship, family support, and knowledge about the disorder and the intended medication can increase medication adherence and improve treatment outcomes 1.

From the Research

Transitioning from Vyvanse to Strattera

To transition from Vyvanse (lisdexamfetamine) to Strattera (atomoxetine), consider the following steps:

• Consult a healthcare professional before making any changes to your medication regimen.
• Gradually taper off Vyvanse under medical supervision to minimize potential withdrawal symptoms.
• Start taking Strattera at a low dose and gradually increase as directed by your healthcare provider.
• Monitor your symptoms and side effects closely during the transition period.

Key Considerations

• The efficacy and safety of lisdexamfetamine and atomoxetine have been compared in several studies 2, 3, 4, 5, 6.
• Lisdexamfetamine has been shown to have a faster and more robust treatment response than atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) 3, 4.
• Atomoxetine has been associated with a higher risk of certain side effects, such as nausea and vomiting, compared to lisdexamfetamine 3.
• The transition from Vyvanse to Strattera should be individualized and based on the patient's specific needs and medical history.

Study Findings

• A head-to-head study comparing lisdexamfetamine and atomoxetine found that lisdexamfetamine was associated with a faster and more robust treatment response 3.
• Another study found that lisdexamfetamine was associated with significantly higher treatment response rates than atomoxetine across all response criteria examined 4.
• A systematic evidence synthesis of treatments for ADHD in children and adolescents found that lisdexamfetamine had a higher probability of treatment response compared to atomoxetine and methylphenidate 6.