Should a refill of Vyvanse (lisdexamfetamine) be authorized for a patient with stable ADHD, given their doctor is unavailable?

From the Guidelines

A refill of Vyvanse (lisdexamfetamine) should be authorized for this patient with stable ADHD, given their doctor is unavailable, as the benefits of maintaining their current treatment regimen outweigh the risks, especially considering their 8-year history of stability on the medication 1. The patient's stable condition and long history of successful treatment with Vyvanse suggest that the medication is effective and well-tolerated. Given the potential consequences of abruptly stopping the medication, such as withdrawal symptoms and ADHD symptom rebound, it is crucial to maintain continuity of care.

• The patient has been stable on their current dose of Vyvanse for an extended period, indicating a well-established treatment regimen.
• The patient's history of depression, ADHD, and hypertension is well-managed, and there is no indication that their condition has changed significantly.
• The patient is currently out of their HCTZ for hypertension and is working on getting in with a primary care provider, which suggests that they are proactive about their healthcare and willing to seek necessary medical attention.
• The potential risks associated with Vyvanse, such as increased blood pressure and heart rate, are well-documented, but the patient's stable condition and long history of treatment suggest that these risks are manageable 1.
• The benefits of maintaining the patient's current treatment regimen, including the prevention of ADHD symptom rebound and potential withdrawal symptoms, outweigh the risks associated with authorizing a refill without the prescriber's evaluation.

From the FDA Drug Label

Lisdexamfetamine dimesylate capsules are a federally controlled substance (CII) because it contains lisdexamfetamine dimesylate that can be a target for people who abuse prescription medicines or street drugs Lisdexamfetamine dimesylate capsules may cause serious side effects, including: Abuse, misuse, and addiction. Your healthcare provider should check you or your child's risk for abuse, misuse, and addiction before starting treatment with lisdexamfetamine dimesylate capsules and will monitor you or your child during treatment.

The patient has been stable on ADHD medication for 8 years, and the request is for a refill of a previously prescribed medication. Authorization of a refill of Vyvanse (lisdexamfetamine) may be considered, given the patient's stable condition and previous prescription history. However, it is crucial to exercise caution due to the potential for abuse, misuse, and addiction associated with lisdexamfetamine.

• The patient's healthcare provider should be contacted as soon as possible to confirm the refill and discuss any concerns.
• The patient should be monitored for any signs of abuse, misuse, or addiction.
• It is essential to ensure that the patient is aware of the potential risks and benefits of the medication and is using it as directed. 2

From the Research

Patient Profile

• Age: 55 years old
• Medical History: Depression, ADHD, Hypertension (HTN)
• Current Medication: Vyvanse 40mg 1 tab QD for ADHD
• Request: Refill of Vyvanse due to being completely out, as primary doctor (Dr. Cobb) is currently unavailable

Medication Overview

• Vyvanse (lisdexamfetamine) is a stimulant prodrug used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults 3
• Studies have shown that lisdexamfetamine is effective in reducing ADHD symptoms and improving quality of life in patients with ADHD 3, 4, 5

Safety and Efficacy

• Lisdexamfetamine has been shown to be safe and efficacious in the treatment of ADHD, with common side effects including decreased appetite, insomnia, and headache 3, 6
• Long-term studies have demonstrated the safety and efficacy of lisdexamfetamine in children and adolescents with ADHD, with a similar safety profile to other stimulants 6, 5

Considerations for Refill

• The patient has been stable on Vyvanse for 8 years, suggesting a well-established treatment regimen
• The patient's primary doctor is currently unavailable, but the patient is in need of a refill to maintain their treatment regimen
• Given the patient's stable medical history and established treatment regimen, a refill of Vyvanse may be authorized to ensure continuity of care 3, 4, 5