From the Guidelines
Vyvanse (lisdexamfetamine) is not recommended for treating methamphetamine dependence due to the lack of robust clinical evidence supporting its effectiveness and the potential for misuse and dependence. The most recent and highest quality study, a systematic review and network meta-analysis published in 2018 1, supports the use of combined contingency management plus community reinforcement approach as the most effective and acceptable intervention for both short- and long-term treatment of individuals with cocaine and/or amphetamine addiction. This study highlights the importance of psychosocial treatments for stimulant use disorders due to the lack of validated pharmacological or brain-stimulation-based treatment for cocaine and/or amphetamine addiction.
Key points to consider in treating methamphetamine dependence include:
- Behavioral therapies, such as cognitive-behavioral therapy, contingency management, and support groups, have demonstrated effectiveness in treating stimulant dependence 1
- There is no pharmacologic treatment for stimulant dependence that can be recommended for use in the primary care setting 1
- Medications like bupropion, naltrexone, and mirtazapine have limited evidence for treating methamphetamine dependence
- Vyvanse, with its stimulant properties, poses a risk for substituting one dependency for another and should only be considered under close medical supervision for patients with co-occurring ADHD and methamphetamine use disorder
In real-life clinical practice, it is crucial to prioritize comprehensive treatment from addiction specialists who can provide appropriate behavioral interventions and consider medication options based on individual circumstances, rather than relying on off-label use of medications like Vyvanse. The lack of robust clinical evidence supporting the effectiveness of Vyvanse for methamphetamine dependence, combined with its potential for misuse and dependence, makes it a less desirable treatment option compared to evidence-based psychosocial interventions 1.
From the Research
Effectiveness of Vyvanse (Lisdexamfetamine) for Treating Methamphetamine Dependence
- There is limited research directly assessing the effectiveness of Vyvanse (lisdexamfetamine) for treating methamphetamine dependence 2.
- A study protocol for a randomized, double-blind, placebo-controlled trial of lisdexamfetamine for the treatment of methamphetamine dependence has been established, but the results are not yet available 2.
- Other studies have investigated various pharmacotherapies for amphetamine dependence, including methylphenidate, bupropion, modafinil, and naltrexone, which have shown some limited evidence of benefit for reducing amphetamine use 3, 4.
- Dexamphetamine has been studied, and while it may have benefits on secondary outcomes such as treatment retention, it has not been shown to reduce amphetamine use 3.
- A review of pharmacological approaches to methamphetamine dependence found that several medications, including bupropion, mirtazapine, baclofen, and topiramate, may be beneficial in treating methamphetamine-dependent patients, but more research is needed 5.
- The development of effective pharmacotherapies for methamphetamine dependence is an active area of research, with several promising agents being targeted for further study 6, 4.