What to do if fatigue occurs while tapering off Vyvanse (lisdexamfetamine)?

Managing Fatigue During Vyvanse Tapering

For patients experiencing fatigue while tapering off Vyvanse (lisdexamfetamine), a gradual tapering schedule with supportive interventions to address fatigue is strongly recommended.

Understanding Fatigue During Stimulant Tapering

Fatigue is a common withdrawal symptom when tapering stimulant medications like Vyvanse. This occurs because:

• The body has adapted to the stimulant effects and needs time to readjust
• Underlying ADHD symptoms may re-emerge
• Neurotransmitter systems need time to rebalance

Recommended Approach for Managing Fatigue

1. Optimize Tapering Schedule

• Implement a slower tapering schedule - Reduce by 10% of the current dose per month rather than faster reductions 1
• For example:
  • Week 1-4: Reduce by 10% of current dose
  • Maintain this dose for 3-4 weeks before next reduction
  • Slow down even further if fatigue becomes significant

2. Address Fatigue Directly

• Exercise intervention - Begin with low-level activities that gradually increase over time 1

  • Start with 10-15 minute walks daily
  • Gradually increase duration and intensity as tolerated
  • Morning exercise may be particularly helpful for daytime energy

• Sleep hygiene optimization

  • Maintain consistent sleep/wake schedule
  • Avoid screens 1-2 hours before bedtime
  • Ensure adequate sleep duration (7-9 hours)

• Nutritional interventions

  • Eat smaller, more frequent meals to maintain energy levels
  • Focus on complex carbohydrates and protein
  • Stay well-hydrated
  • Consider temporary caffeine use (if not contraindicated) during morning hours only

3. Medication Review and Adjustments

• Review all current medications for potential contributions to fatigue 1

  • Check for interactions that may worsen fatigue
  • Consider timing adjustments of Vyvanse dose (earlier in day) to prevent sleep disruption

• Consider temporary supportive medications if fatigue is severe:

  • Non-stimulant ADHD medications may help bridge the transition
  • Avoid benzodiazepines which can worsen fatigue 1

4. Monitor for Complications

• Differentiate between withdrawal-related fatigue and other causes
• Watch for signs of depression which may manifest as fatigue
• Assess for sleep disorders that may be unmasked during tapering

Common Pitfalls to Avoid

1. Tapering too quickly - This is the most common error and can significantly worsen fatigue 1
2. Misinterpreting fatigue as need to restart medication - Temporary fatigue is expected and not necessarily indication to resume previous dose
3. Neglecting non-pharmacological interventions - Exercise and sleep hygiene are crucial
4. Inconsistent tapering schedule - Irregular dose reductions can worsen withdrawal symptoms
5. Failing to prepare the patient - Education about expected withdrawal symptoms helps with adherence

Special Considerations

• If fatigue becomes severe or debilitating, consider pausing the taper at current dose until symptoms improve
• Document fatigue levels using a simple 0-10 scale to track improvement or worsening
• Remember that withdrawal symptoms including fatigue are typically temporary and will improve with time

By implementing these strategies, patients can successfully navigate Vyvanse tapering while minimizing the impact of fatigue on daily functioning and quality of life.