What is the recommended treatment approach using sustained release amphetamines, such as Adderall (amphetamine and dextroamphetamine) and Vyvanse (lisdexamfetamine), for Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

The recommended treatment approach for ADHD using sustained release amphetamines, such as Adderall XR and Vyvanse, typically begins with a low dose that is gradually titrated upward until optimal symptom control is achieved with minimal side effects, as supported by recent evidence 1.

Key Considerations

• For Adderall XR (extended-release), the initial dose is usually 5-10 mg once daily in the morning, with potential increases of 5-10 mg weekly to a maximum of 30 mg daily for adults or 20-30 mg for children, depending on age and weight.
• Vyvanse treatment typically starts at 30 mg once daily in the morning, with possible weekly increases of 10-20 mg up to a maximum of 70 mg daily.
• These medications should be taken in the morning to minimize sleep disturbances, and patients should be regularly monitored for side effects such as decreased appetite, insomnia, increased heart rate, and blood pressure.

Monitoring and Adjustments

• Treatment effectiveness should be assessed every 3-6 months, with periodic "drug holidays" (typically during school breaks for children) considered to evaluate continued need and minimize tolerance.
• Medication adherence should be regularly assessed, and potential issues in adherence openly discussed, as non-adherence may lead to reduced effectiveness and increased adverse events 1.

Comprehensive Treatment Plan

• These medications work by increasing dopamine and norepinephrine levels in the brain, which improves attention, focus, and impulse control.
• They should be used as part of a comprehensive treatment plan that may include behavioral therapy, educational support, and lifestyle modifications to maximize effectiveness and minimize the required medication dose, as emphasized by recent guidelines 1.

Individualized Approach

• The treatment approach should be individualized, taking into account the severity of symptoms, presence of comorbidities, and patient preferences, as well as the potential benefits and limitations of non-stimulant medication, such as atomoxetine and guanfacine 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

Lisdexamfetamine Dimesylate Capsules are indicated for the treatment of: Attention Deficit Hyperactivity Disorder (ADHD) in adults and pediatric patients 6 years and older

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action Lisdexamfetamine is a prodrug of dextroamphetamine. Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. The exact mode of therapeutic action in ADHD and BED is not known.

The recommended treatment approach using sustained release amphetamines, such as Adderall (amphetamine and dextroamphetamine) and Vyvanse (lisdexamfetamine), for Attention Deficit Hyperactivity Disorder (ADHD) is to use them as indicated for the treatment of ADHD in adults and pediatric patients 6 years and older.

• Key points:
  • Lisdexamfetamine is a prodrug of dextroamphetamine.
  • Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity.
  • The exact mode of therapeutic action in ADHD is not known.
  • Lisdexamfetamine dimesylate capsules are indicated for the treatment of ADHD in adults and pediatric patients 6 years and older 2 2 2.

From the Research

Sustained Release Amphetamines for ADHD

• Sustained release amphetamines, such as Adderall (amphetamine and dextroamphetamine) and Vyvanse (lisdexamfetamine), are commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) 3, 4.
• The optimal treatment of ADHD aims to reduce core symptoms for as much of the waking hours as possible, leading to longer-acting delivery formats 3.
• Amphetamine preparations are one of the two categories of stimulant medications approved for the treatment of ADHD, with a favorable side effect profile and rapid onset of action 3, 5.

Treatment Approach

• The treatment approach using sustained release amphetamines involves individualizing treatment to meet the specific needs of patients, taking into account factors such as difficulty swallowing whole pills 3, 4.
• Clinicians can choose from a variety of formulations, including chewable tablets, capsules that can be opened and sprinkled, and liquid formulations 3, 4.
• The choice of formulation may depend on factors such as the patient's age, ability to swallow pills, and personal preference 4.

Efficacy and Safety

• Studies have shown that amphetamines are effective in reducing the severity of ADHD symptoms in both children and adults 5, 6.
• However, amphetamines are associated with a number of adverse events, including decreased appetite, insomnia, abdominal pain, and anxiety 5, 6.
• The long-term safety and effectiveness of sustained release amphetamines have been demonstrated in studies, with sustained symptomatic improvement for up to 24 months 7.

Considerations

• Clinicians should be aware of the potential for adverse events and monitor patients closely when prescribing sustained release amphetamines 5, 6.
• The choice of amphetamine preparation and release formulation should be based on individual patient needs and preferences 4, 6.
• Further research is needed to fully understand the efficacy and safety of sustained release amphetamines for ADHD, particularly in the long term 5, 6.