From the Guidelines
The recommended crosstapering schedule between Vyvanse (lisdexamfetamine) 40mg and atomoxetine involves gradually reducing Vyvanse by 10mg every 1-2 weeks while simultaneously introducing and increasing atomoxetine, starting at 25mg or 40mg daily and titrating up to the target dose of 80-100mg for adults or 1.2-1.4mg/kg for children. This approach is based on the understanding that atomoxetine, a non-stimulant, takes 2-4 weeks to reach therapeutic levels, and a gradual transition helps minimize withdrawal effects from Vyvanse, a stimulant, which increases dopamine and norepinephrine immediately 1.
Key Considerations for Crosstapering
- The transition should be individualized and supervised by a healthcare provider to monitor for side effects, including changes in heart rate, blood pressure, mood, or sleep patterns.
- Atomoxetine's delayed onset of action, typically 2-4 weeks, should be considered when planning the crosstapering schedule.
- The most common adverse effects of atomoxetine, such as nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence, should be closely monitored during the transition 1.
- Patients with preexisting cardiovascular diseases or significant cardiac abnormalities should be closely monitored, as atomoxetine may have cardiovascular effects similar to stimulants 1.
Titration and Dosing
- Start atomoxetine at 25mg or 40mg daily for 7-14 days, then increase to the target dose.
- The maximum recommended dosage of atomoxetine is 1.4 mg/kg/day or 100 mg/day, whichever is lower.
- Vyvanse should be reduced by 10mg every 1-2 weeks, from 40mg to 30mg to 20mg to 10mg, while introducing and increasing atomoxetine.
Monitoring and Adjustments
- Patients should report any side effects or changes in their condition to their healthcare provider, who may adjust the crosstapering schedule accordingly.
- Close monitoring is essential, especially during the first few months of treatment or at times of dose change, for suicidality, clinical worsening, and unusual changes of behavior 1.
From the Research
Crosstapering Schedule between Vyvanse 40mg and Atomoxetine
The recommended crosstapering schedule between Vyvanse (lisdexamfetamine) 40mg and atomoxetine is not explicitly stated in the provided studies. However, some studies provide guidance on switching from stimulants to atomoxetine:
- A study published in 2008 2 suggests that atomoxetine may be initiated by a schedule of dose increases and cross-tapering with methylphenidate.
- A study published in 2007 3 describes a stepwise transition from methylphenidate or amphetamine to atomoxetine, where patients receive full-dose psychostimulant plus 0.5 mg/kg/day atomoxetine for 1 week, followed by half-dose psychostimulant plus 1.2 mg/kg/day atomoxetine for 1 week, and then atomoxetine monotherapy.
Key Considerations
When switching from Vyvanse to atomoxetine, the following considerations should be taken into account:
- The difference in pharmacodynamics between stimulants and atomoxetine may require a stepwise cross-titration to control ADHD symptoms during the transition period 3.
- Close monitoring of blood pressure and heart rate is necessary when co-administering atomoxetine with stimulants 2.
- A trial period of at least 6-8 weeks is recommended to evaluate the overall tolerability and efficacy of atomoxetine 2.
Tolerability and Efficacy
Studies have shown that switching from stimulants to atomoxetine can be successful, with resulting improvement in ADHD symptom severity:
- A pilot study published in 2007 3 found that children and adolescent patients were successfully switched from methylphenidate or amphetamine to atomoxetine, with significant improvement in ADHD symptoms.
- A head-to-head study published in 2014 4 found that lisdexamfetamine dimesylate (Vyvanse) was associated with significantly higher treatment response rates than atomoxetine in children and adolescents with ADHD.